Provider Demographics
NPI:1275867376
Name:JERKINS INC
Entity Type:Organization
Organization Name:JERKINS INC
Other - Org Name:BUBBA'S MEDICINE SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-749-3426
Mailing Address - Street 1:2263 POTOMAC CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4261
Mailing Address - Country:US
Mailing Address - Phone:334-826-6194
Mailing Address - Fax:334-742-0757
Practice Address - Street 1:512 2ND AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4316
Practice Address - Country:US
Practice Address - Phone:334-749-3426
Practice Address - Fax:334-742-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1018903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy