Provider Demographics
NPI:1790820785
Name:EAST JACKSON FAMILY PHARMACY
Entity Type:Organization
Organization Name:EAST JACKSON FAMILY PHARMACY
Other - Org Name:WEST TN HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DPH
Authorized Official - Prefix:MS
Authorized Official - First Name:ARRIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-425-7909
Mailing Address - Street 1:655 LEXINGTON AVE
Mailing Address - Street 2:ATTN.PHARMACY
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-5075
Mailing Address - Country:US
Mailing Address - Phone:731-425-7909
Mailing Address - Fax:731-265-5087
Practice Address - Street 1:655 LEXINGTON AVE
Practice Address - Street 2:ATTN.PHARMACY
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-5075
Practice Address - Country:US
Practice Address - Phone:731-425-7909
Practice Address - Fax:731-265-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty