John Smith Professional Pharmacy, Inc.

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

60 Issued in TN

Legal business name

JOHN SMITH PROFESSIONAL PHARMACY, INC.

Practice address

100 Lantana Rd
Ste. 201
Crossville, TN 38555-1903

Phone

(931) 484-1434

Fax

(931) 456-2853

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Vicki S Upchurch, DPHNPI 1770613424

Title

Pharmacist/Owner

Phone

(931) 484-1434

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

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 2

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

• Vicki S Upchurch, D.PH.

  • Pharmacist
  • Crossville, TN
  • NPI 1770613424
  NPD Authorized official
• Cindy Wakham, D.PH.

  • Pharmacist
  • Crossville, TN
  • NPI 1588709158
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669412144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 LANTANA RD",
            "address_2": "STE. 201",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385551903",
            "telephone_number": "931-484-1434",
            "fax_number": "931-456-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LANTANA RD",
            "address_2": "STE. 201",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385551903",
            "telephone_number": "931-484-1434",
            "fax_number": "931-456-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN SMITH PROFESSIONAL PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "UPCHURCH",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "931-484-1434",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TN",
            "license": "60",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3513437",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4405797",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Innovative Restorations LLC
• Iriz Perez
• Donathan M Ivey, MD
• Holly Ann Jackle, LCSW
• Tyler Justin Jensen, DPT
• Shannon Johns, SLP-CCC
• Johnson Family Medicine LLC
• Deborah Ann Johnson, EDS LPC MHSP
• Grayson Banks Johnson, DC
• James S Johnson, MD

• Long Term Care Pharmacy in Crossville, TN
• Providers in Crossville, TN by specialty
• Long Term Care Pharmacy in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.