Provider Demographics
NPI:1093776049
Name:DUREN, JERRY M (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:M
Last Name:DUREN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DEXTER L WOOD MEMORIAL DR
Mailing Address - Street 2:P. O. BOX 736
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2416
Mailing Address - Country:US
Mailing Address - Phone:931-722-5466
Mailing Address - Fax:931-722-9495
Practice Address - Street 1:215 DEXTER L WOOD MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2416
Practice Address - Country:US
Practice Address - Phone:931-722-5466
Practice Address - Fax:931-722-9495
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3913837Medicare PIN
TN1142510001Medicare NSC
TN6598990001Medicare NSC