Organization
JACK W GREENE, DBA
Active
Other names
JEFFERSON COMPOUNDING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK W GREENE D.PH. (OWNER-PHARMACIST)
(865) 483-3007
Entity
Organization
Contact information
Practice address
22 N JEFFERSON CIR, OAK RIDGE, TN 37830-4805
(865) 483-3007
(865) 483-3071
Mailing address
22 N JEFFERSON CIR, OAK RIDGE, TN 37830-4805
(865) 483-3007
(865) 483-3071
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
1122
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1122
ST OF TN BOARD OF PHARMAC
TN
01
—
4410673
NCPDP
TN
Enumeration date
04/20/2007
Last updated
07/18/2007
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