NPIMap

Organization Active NPI

Jackson Clinic Pharmacy Inc

  • Clinic Pharmacy
  • Jackson, TN
National Provider Identifier
1477668416
Registry record updated Jun 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
454 Issued in TN
Legal business name
JACKSON CLINIC PHARMACY INC
Doing business as
JACKSON CLINIC PHARMACY
Practice address
616 W Forest Ave
Jackson, TN 38301-3902
Phone
(731) 422-0232
Fax
(731) 422-0389
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2013

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

Authorized official

Name
Darlene Patton, DPH
Title
Phcy Dir
Phone
(731) 422-0232

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Clinic Pharmacy 3336C0002X 454 TN Primary
Community/Retail Pharmacy 3336C0003X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

616 W Forest Ave
Jackson, TN 38301-3902

Mailing address

616 W Forest Ave
Jackson, TN 38301-3902
Phone (731) 422-0232

Other identifiers 1

IdentifierTypeStateIssuer
2095588OtherPK

Other names 1

  • JACKSON CLINIC PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jackson Clinic Innovation Park Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370995200000",
    "number": "1477668416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013902",
            "telephone_number": "731-422-0232",
            "fax_number": "731-422-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W FOREST AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013902",
            "telephone_number": "731-422-0232",
            "fax_number": "731-422-0389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2013-06-12",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_title_or_position": "PHCY DIR",
        "authorized_official_telephone_number": "731-422-0232",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TN",
            "license": "454",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2095588",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON CLINIC PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.