NPIMap

Organization Active NPI

Jackson Clinic Pharmacy Inc

  • Community/Retail Pharmacy
  • Jackson, TN
National Provider Identifier
1831228618
Registry record updated May 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2987 Issued in TN
Legal business name
JACKSON CLINIC PHARMACY INC
Doing business as
JACKSON NORTH CLINIC PHARMACY
Practice address
2863 Highway 45 Byp
Jackson, TN 38305-3618
Phone
(731) 664-8046
Fax
(731) 660-8339
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2015

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

Authorized official

Name
Jean Gray Hunderup, DPH
Title
Pharmacist in Charge Noah
Phone
(731) 664-8046

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 2987 TN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

2863 Highway 45 Byp
Jackson, TN 38305-3618

Mailing address

2863 Highway 45 Byp
Jackson, TN 38305-3618
Phone (731) 664-8046

Other identifiers 1

IdentifierTypeStateIssuer
2091766OtherPK

Other names 1

  • JACKSON NORTH 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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1831228618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2863 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053618",
            "telephone_number": "731-664-8046",
            "fax_number": "731-660-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2863 HIGHWAY 45 BYP",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053618",
            "telephone_number": "731-664-8046",
            "fax_number": "731-660-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CLINIC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "GRAY HUNDERUP",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE NOAH",
        "authorized_official_telephone_number": "731-664-8046",
        "authorized_official_credential": "DPH"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "2987",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2091766",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKSON NORTH 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 May 29, 2015; 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.