Provider Demographics
NPI:1083759963
Name:PHIPPS PHARMACY INC
Entity Type:Organization
Organization Name:PHIPPS PHARMACY INC
Other - Org Name:PHIPPS PHARMACY WAVERLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-352-0820
Mailing Address - Street 1:205B HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1649
Mailing Address - Country:US
Mailing Address - Phone:931-296-3703
Mailing Address - Fax:931-296-3593
Practice Address - Street 1:211 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1510
Practice Address - Country:US
Practice Address - Phone:931-296-3703
Practice Address - Fax:931-296-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038714Medicaid