Provider Demographics
NPI:1881055564
Name:JIMS PHARMACY LLC
Entity type:Organization
Organization Name:JIMS PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-310-9278
Mailing Address - Street 1:6378 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-6727
Mailing Address - Country:US
Mailing Address - Phone:256-373-3449
Mailing Address - Fax:256-373-3359
Practice Address - Street 1:6378 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-6727
Practice Address - Country:US
Practice Address - Phone:256-373-3449
Practice Address - Fax:256-373-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
AL1146023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158847OtherPK