Provider Demographics
NPI:1457489312
Name:JERRY M DUREN
Entity Type:Organization
Organization Name:JERRY M DUREN
Other - Org Name:WAYNE COUNTY GENERAL HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IS CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MCCLAIN
Authorized Official - Last Name:DUREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-722-2038
Mailing Address - Street 1:103 JV MANGUBAT DR
Mailing Address - Street 2:P.O. BOX 736
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2440
Mailing Address - Country:US
Mailing Address - Phone:931-722-2038
Mailing Address - Fax:931-722-6879
Practice Address - Street 1:103 JV MANGUBAT DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2440
Practice Address - Country:US
Practice Address - Phone:931-722-2038
Practice Address - Fax:931-722-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0018663336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN001866OtherLICENSE ID NUMBER
TNBW3976404OtherDEA LICENSE NUMBER