Provider Demographics
NPI:1871522029
Name:JIFFY WESTSIDE PHARMACY
Entity type:Organization
Organization Name:JIFFY WESTSIDE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:2562-332-3307
Mailing Address - Street 1:1204 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-4769
Mailing Address - Country:US
Mailing Address - Phone:256-233-2307
Mailing Address - Fax:256-233-0865
Practice Address - Street 1:1204 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4769
Practice Address - Country:US
Practice Address - Phone:256-233-2307
Practice Address - Fax:256-233-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0114708OtherAETNA
AL0114708OtherMEDCO
AL0114708OtherACCESS HEALTH
AL0114708OtherSCRIPT SAV
AL011470OtherSAV RX
ALM5010 009OtherFIRST HEALTH DME
AL0114708OtherFIRST HEALTH TENNCARE
AL51060261OtherBC BS PHARMACY
AL0114708OtherEXPRESS SCRIPTS
AL0114708OtherARGUS
AL011470OtherCAREMARK