ASHLEY N TANNER I I I
200 W Main St
Jackson, TN 38301
731-427-1528
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 3336C0003X | Suppliers - Pharmacy - Community/Retail Pharmacy | TN | 000000690 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
3534364 | TN | MEDICAID | |
NCPDP | 4406977 | TN | OTHER |