Provider Demographics
NPI:1588670319
Name:JEFFREY ALLAN ANDERSON
Entity Type:Organization
Organization Name:JEFFREY ALLAN ANDERSON
Other - Org Name:ANDERSON DRUGS AND HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:423-263-7824
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:725 TENNESSEE AVE.
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-0368
Mailing Address - Country:US
Mailing Address - Phone:423-263-7824
Mailing Address - Fax:423-263-5714
Practice Address - Street 1:725 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1305
Practice Address - Country:US
Practice Address - Phone:423-263-7824
Practice Address - Fax:423-263-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6691183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454338Medicaid