Provider Demographics
NPI:1871102624
Name:TRIGG, JAKE
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:TRIGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2501
Mailing Address - Country:US
Mailing Address - Phone:901-383-4847
Mailing Address - Fax:
Practice Address - Street 1:3860 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2501
Practice Address - Country:US
Practice Address - Phone:901-383-4847
Practice Address - Fax:901-383-4848
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN443111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist