Provider Demographics
NPI:1962973438
Name:ASHLAND CITY PHARMACY LLC
Entity type:Organization
Organization Name:ASHLAND CITY PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-857-5269
Mailing Address - Street 1:605 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1320
Mailing Address - Country:US
Mailing Address - Phone:615-246-1422
Mailing Address - Fax:615-246-1423
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1320
Practice Address - Country:US
Practice Address - Phone:615-246-1422
Practice Address - Fax:615-246-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ047718Medicaid