Provider Demographics
NPI:1417018698
Name:JEFFCO RUTLEDGE DRUGS
Entity type:Organization
Organization Name:JEFFCO RUTLEDGE DRUGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CABBAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-828-5222
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-0406
Mailing Address - Country:US
Mailing Address - Phone:865-828-5222
Mailing Address - Fax:865-828-5959
Practice Address - Street 1:8120 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-0406
Practice Address - Country:US
Practice Address - Phone:865-828-5222
Practice Address - Fax:865-828-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0996530001Medicare NSC