Jay Dee Glass
Individual provider Active NPI Pharmacist · Waynesboro, TN
NPI 1962916320 · NPPES record last updated Nov 21, 2017
Key facts
- NPI
- 1962916320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 3990 (TN)
- Practice address
- 215 Dexter L Woods Memorial Blvd
Waynesboro, TN 38485-2416 - Phone
- (931) 722-5466
- NPI assigned
- Nov 21, 2017
- Sex
- Male
- Sole proprietor
- No
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3990 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duren Clinical Services, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3990 | TN | Yes |
Addresses
Primary practice location
215 Dexter L Woods Memorial Blvd
Waynesboro, TN 38485-2416
Mailing address
1184 Prosser Rd
Leoma, TN 38468-5050
Other providers in Waynesboro, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2017. 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.