NPIMap

Organization Active NPI

Phipps Pharmacy Inc

Doing business as Phipps Pharmacy Waverly

  • Community/Retail Pharmacy
  • Waverly, TN
National Provider Identifier
1083759963
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PHIPPS PHARMACY INC
Doing business as
Phipps Pharmacy Waverly
Practice address
211 West Main Street
Waverly, TN 37185-1510
Phone
(931) 296-3703
Fax
(931) 296-3593
NPI assigned
Feb 20, 2007
Last updated
Sep 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Authorized official

Name
Jerry Robert PhippsNPI 1306049630
Title
Owner
Phone
(731) 352-0820

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

211 West Main Street
Waverly, TN 37185-1510

Mailing address

15385 Highland Dr
MC Kenzie, TN 38201-2501
Phone (931) 296-3703

Other identifiers 1

IdentifierTypeStateIssuer
Q068226MedicaidTN

Other names 1

  • Phipps Pharmacy Waverly Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181211002460 TN Part B Supplier - Mass Immunization (Roster Biller Only) 0941411789 Practice locations: Waverly, TN
O20210825000580 TN Part B Supplier - Mass Immunization (Roster Biller Only) 7719188978 Practice locations: Waverly, TN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2235713Phipps Pharmacy Waverly211 West Main Street, Waverly, TN 37185Certificate of waiverSep 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Phipps Pharmacy Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

211 W Main St
Waverly, TN 37185
Phone (931) 296-3703

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757462400000",
    "number": "1083759963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15385 HIGHLAND DR",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382012501",
            "telephone_number": "931-296-3703",
            "fax_number": "931-296-3593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 WEST MAIN STREET",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851510",
            "telephone_number": "931-296-3703",
            "fax_number": "931-296-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHIPPS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A",
        "authorized_official_last_name": "PHIPPS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-352-0820"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q068226",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phipps Pharmacy Waverly",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waverly, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.