Provider Demographics
NPI:1891123675
Name:JAMES AND WILKS PHARMACY LLC
Entity Type:Organization
Organization Name:JAMES AND WILKS PHARMACY LLC
Other - Org Name:JAMES & WILKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MART
Authorized Official - Middle Name:WHITIS
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:731-445-8923
Mailing Address - Street 1:620 MALL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1649
Mailing Address - Country:US
Mailing Address - Phone:731-286-2025
Mailing Address - Fax:731-882-1978
Practice Address - Street 1:620 MALL BLVD STE A
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1649
Practice Address - Country:US
Practice Address - Phone:731-286-2025
Practice Address - Fax:731-882-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5242OtherTENNESSEE BOARD OF PHARMACY LICENSE
=========OtherEIN