Jeff City Pharmacist Group LLC Dba MD Pharmacy Store 2

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2

Doing business as

M.D. Pharmacy Store 2

Practice address

657 E Broadway Blvd
Jefferson City, TN 37760

Phone

(865) 262-9777

Fax

(865) 262-9778

NPI assigned

Jan 13, 2016

Last updated

May 28, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joshua R Blake, PHARMDNPI 1831442599

Title

Pic

Phone

(865) 262-9777

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 2

• M.D. Pharmacy Store 2 Doing business as
• Bunch Medical, LLC DBA MD Pharmacy Store 2 Former legal business name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joshua Ryne Blake

  • Pharmacist
  • Johnson City, TN
  • NPI 1831442599
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1073979522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 E BROADWAY BLVD",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "37760",
            "telephone_number": "865-262-9777",
            "fax_number": "865-262-9778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 E BROADWAY BLVD",
            "city": "JEFFERSON CITY",
            "state": "TN",
            "postal_code": "37760",
            "telephone_number": "865-262-9777",
            "fax_number": "865-262-9778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFF CITY PHARMACIST GROUP LLC DBA MD PHARMACY STORE 2",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-13",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "865-262-9777",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "5720",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2157383",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q033187",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M.D. Pharmacy Store 2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bunch Medical, LLC DBA MD Pharmacy Store 2",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kevin Dwayne Hyatt, B.S.
• Independant Physical Therapy
• Denette Jackson, APRN
• Rachel Jackson, ATC
• Stephanie M James, PHARMD
• Jefferson City Operations, LLC (Life Care Center of Jefferson City)
• Jefferson City Senior Center
• Jefferson County EMS
• Jefferson County Hma LLC (Tennova Healthcare-Jefferson Memorial Hospital)
• Jefferson County Hma, LLC (Tennova Healthcare-Jefferson Memorial Hospital)

• Pharmacy in Jefferson City, TN
• Providers in Jefferson City, TN by specialty
• Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.