Provider Demographics
NPI:1487201356
Name:JOYNER, JACK TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:TYLER
Last Name:JOYNER
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 1:154 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1529
Mailing Address - Country:US
Mailing Address - Phone:731-610-0104
Mailing Address - Fax:
Practice Address - Street 1:185 W COURT AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2133
Practice Address - Country:US
Practice Address - Phone:731-610-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty