Jessica Marie Bodine
Individual provider Active NPI Pharmacist · Dresden, TN
NPI 1972107464 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1972107464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 37616 (TN)
- Practice address
- 6616 Greenfield Hwy 54
Dresden, TN 38225-1714 - Phone
- (731) 364-3161
- NPI assigned
- Nov 24, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 37616 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 37616 | TN | Yes |
Addresses
Primary practice location
6616 Greenfield Hwy 54
Dresden, TN 38225-1714
Mailing address
460 Ridgecrest Dr
Greenfield, TN 38230-1286
Phone (731) 514-1404
Other providers in Dresden, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. 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.