Windham Drug Jellico, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WINDHAM DRUG JELLICO, INC

Practice address

1184 5TH St
Jellico, TN 37762-2629

Phone

(423) 784-3630

NPI assigned

May 3, 2017

Organization subpart

No

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

Authorized official

Name

Justin Smith, PHARM.D.

Title

Vice-President

Phone

(423) 784-3630

Specialties & licenses 2

Addresses

Other names 1

• Windham Drug Jellico Doing business as

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Locations

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

• Jamie Ratliff, PHARMD

  • Pharmacist
  • Red Bank, TN
  • NPI 1225445844
  NPD
• Emily Terry, PHARMD

  • Pharmacist
  • Jellico, TN
  • NPI 1932042728
  NPD (past)

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

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1578099016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1184 5TH ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622629",
            "telephone_number": "423-784-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1184 5TH ST",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377622629",
            "telephone_number": "423-784-3630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDHAM DRUG JELLICO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-03",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "423-784-3630",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windham Drug Jellico",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marybelle Walden, CHIROPRACTOR DC
• Walgreen Co
• Natalie Ruth Wilbanks, PA-C
• Wilkens Medical Group Inc.
• Darryl John Wilkens, M.D.
• Rebekkah M Witten, LCSW
• Daniel Eugene Yoder Jr., MD

• All providers in Jellico, TN
• Community/Retail Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; 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.