Provider Demographics
NPI:1831207695
Name:BANGS, JERRY DON (RPH)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:DON
Last Name:BANGS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2327 GARRISON CV
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1805
Mailing Address - Country:US
Mailing Address - Phone:615-556-2492
Mailing Address - Fax:615-867-5410
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:PHARMACY SVE 119
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-867-6000
Practice Address - Fax:615-867-5410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN22876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist