JEFFCO DRUG CENTER IN JEFFERSON CITY
NPI 1043364490
Pharmacy - Community/Retail Pharmacy in Jefferson City, TN

Q: What is Mountain Valley Rx 05 Inc's NPI number?

The NPI number for Mountain Valley Rx 05 Inc is 1043364490. It was assigned to this organization in the NPPES registry on January 23, 2007. The provider is doing business as Jeffco Drug Center In Jefferson City.

Q: What is Mountain Valley Rx 05 Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since January 23, 2007

153 E BROADWAY BLVD, STE 103, JEFFERSON CITY, TN 37760(865) 471-5111(865) 471-5199 Get Directions Write a Review

NPPES record last updated: March 30, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jeffco Drug Center In Jefferson City NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFCO DRUG CENTER IN JEFFERSON CITY (NPI 1043364490) is a healthcare organization registered as a community/retail pharmacy in Jefferson City, Tennessee and active in the NPI registry since January 2007. The organization lists Beau Kisabeth, Manager, as its authorized official.

NPPES Registry Identity

NPI1043364490

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameMOUNTAIN VALLEY RX 05 INC

Location Address153 E BROADWAY BLVD, STE 103Jefferson City, TN 37760-2517

Mailing AddressPo Box 385Dandridge, TN 37725-0385 · (865) 475-9969 · Fax (865) 475-9901

Phone(865) 471-5111

Fax(865) 471-5199

Organization SubpartNo

Authorized OfficialBeau KisabethManager · (865) 388-3211

Enumeration DateJanuary 23, 2007

Last NPPES UpdateMarch 30, 2010

✔ NPI 1043364490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in TN · 3918

Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

153 E BROADWAY BLVD, Jefferson City, TN 37760

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Other Names 1

Doing Business AsJeffco Drug Center In Jefferson City

Other Identifiers 2

Other4437364Ncpdp Provider Identification Number

Medicare NSC4314720002

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SALLY RUTH HENSLEY APRN, FNP

Nurse Practitioner (Family)