1710268065 NPI number — DR. JIMMY NEIL MCBRIDE PHARM.D.

Table of content: DR. JIMMY NEIL MCBRIDE PHARM.D. (NPI 1710268065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710268065 NPI number — DR. JIMMY NEIL MCBRIDE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBRIDE
Provider First Name:
JIMMY
Provider Middle Name:
NEIL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710268065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 EAGLE BEND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37716-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-457-5134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1130 NORTH CHARLES G. SEIVERS BOULEVARD
Provider Second Line Business Practice Location Address:
CLINTON DRUG STORE
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-457-1421
Provider Business Practice Location Address Fax Number:
865-457-9164
Provider Enumeration Date:
08/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  8242 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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