1265568745 NPI number — JONES DRUG STORE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265568745 NPI number — JONES DRUG STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES DRUG STORE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JONES DRUG
Provider Other Organization Name Type Code:
5
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:
1265568745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 723
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEPANTO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72354-0723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-475-2617
Provider Business Mailing Address Fax Number:
870-475-2617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 GREENWOOD AVE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEPANTO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-475-2617
Provider Business Practice Location Address Fax Number:
870-475-2617
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLCOMB
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
870-475-2617

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  AR03953 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100345407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0403953 . This is a "NABP NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: AR03953 . This is a "ARKANSAS STATE LICENSE NU" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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