Provider Demographics
NPI:1710268065
Name:MCBRIDE, JIMMY NEIL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:NEIL
Last Name:MCBRIDE
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 1:1106 EAGLE BEND RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-4004
Mailing Address - Country:US
Mailing Address - Phone:865-457-5134
Mailing Address - Fax:
Practice Address - Street 1:1130 NORTH CHARLES G. SEIVERS BOULEVARD
Practice Address - Street 2:CLINTON DRUG STORE
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716
Practice Address - Country:US
Practice Address - Phone:865-457-1421
Practice Address - Fax:865-457-9164
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist