Provider Demographics
NPI:1700971264
Name:PHIPPS PHARMACY INC
Entity Type:Organization
Organization Name:PHIPPS PHARMACY INC
Other - Org Name:PHIPPS PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:731-352-0820
Mailing Address - Street 1:205B HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1649
Mailing Address - Country:US
Mailing Address - Phone:731-352-0820
Mailing Address - Fax:731-352-2848
Practice Address - Street 1:19 HUGHES DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1510
Practice Address - Country:US
Practice Address - Phone:731-668-9072
Practice Address - Fax:731-664-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN3083336C0003X, 3336C0004X, 3336L0003X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518370Medicaid
TN4417627OtherNABP
TN1518370Medicaid