Jeff City Pharmacist Group LLC DBA MD Pharmacy Store 2
NPI 1073979522ActiveOrganization· Pharmacy· Jefferson City, TN
Pharmacy in Jefferson City, Tennessee, registered in NPPES in January 2016. The authorized official on file is Joshua R. Blake, PHARMD, Pic. Enrolled in Medicare as part b supplier - mass immunization (roster biller only).
Overview
| NPI | 1073979522 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 13, 2016 |
| Last updated in NPPES | May 28, 2020 |
| Certified by provider | May 28, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy Primary | 333600000X | — | — |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | 5720 | TN |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Mass Immunization (Roster Biller Only) (TN) |
|---|
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