Provider Demographics
NPI:1093981565
Name:GAINES, JODI SLATON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:SLATON
Last Name:GAINES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 AYMETT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-7127
Mailing Address - Country:US
Mailing Address - Phone:931-424-1955
Mailing Address - Fax:
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3214
Practice Address - Country:US
Practice Address - Phone:931-363-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist