Jellico Drug Store Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

472 Issued in TN

Legal business name

JELLICO DRUG STORE INC

Practice address

229 S Main St
Jellico, TN 37762-2018

Phone

(423) 784-6226

Fax

(423) 784-2947

NPI assigned

Jun 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John BairdNPI 1609968981

Title

Owner / Pharmacist / President

Phone

(423) 784-6226

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Walter Baird, R.PH.

  • Pharmacist
  • Jellico, TN
  • NPI 1609968981
  NPD Authorized official

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1093753196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 S MAIN ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622018",
            "telephone_number": "423-784-6226",
            "fax_number": "423-784-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 S MAIN ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622018",
            "telephone_number": "423-784-6226",
            "fax_number": "423-784-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JELLICO DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER / PHARMACIST / PRESIDENT",
        "authorized_official_telephone_number": "423-784-6226",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4407210",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jellico Community Hospital Inc.
• Jellico Community Hospital Inc.
• Jellico Community Hospital LLC
• Jellico Community Hospital, Inc
• Jellico Community Hospital, Inc
• Jellico Emergency Physicians Medical Group PC
• Jellico Healthcare Associates LLC
• Jellico Medical Center, Inc.
• Jellico Regional Hospital, LLC
• Jellico Regional Hospital, LLC

• Community/Retail Pharmacy in Jellico, TN
• Providers in Jellico, TN by specialty
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.