DJB Pharmacy LLC

Key facts

NPI

1245779255

Entity type

Organization (NPI type 2)

Primary specialty

Community/Retail Pharmacy 3336C0003X

License

5950 (TN)

Legal business name

DJB PHARMACY LLC

Practice address

305 Lake Dr Ste 1
Somerville, TN 38068-9724

Phone

(901) 235-7188

Fax

(866) 201-2293

NPI assigned

Feb 23, 2017

Organization subpart

No

Authorized official

Name

Odell Glenn

Title

Pharmacist

Phone

(662) 252-8464

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• DJB Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 7, 2017.

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491523200000",
    "number": "1245779255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 LAKE DR",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380689724",
            "telephone_number": "901-235-7188",
            "fax_number": "866-201-2293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 LAKE DR STE 1",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380689724",
            "telephone_number": "901-235-7188",
            "fax_number": "866-201-2293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DJB PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-23",
        "last_updated": "2017-04-07",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "ODELL",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "662-252-8464"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "5950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2167929",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DJB Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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