Roger Stephen Herndon, RPH
Individual provider Active NPI Pharmacist · Camden, TN
NPI 1831606268 · NPPES record last updated Jan 8, 2018
Key facts
- NPI
- 1831606268
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- C-3785 (TN)
- Practice address
- 175 W Main St
Camden, TN 38320-1621 - Phone
- (731) 584-4711
- Fax
- (731) 584-5906
- NPI assigned
- Jan 8, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-3785 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J & S Pharmacy Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | C-3785 | TN | Yes |
Addresses
Primary practice location
175 W Main St
Camden, TN 38320-1621
Mailing address
175 W Main St
Camden, TN 38320-1621
Phone (731) 584-4711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1452219 | Medicaid | TN |
Other providers in Camden, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.