1528058187 NPI number — JONES PHARMACY ENTERPRISES INC

Table of content: (NPI 1528058187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528058187 NPI number — JONES PHARMACY ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONES PHARMACY ENTERPRISES INC
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:
Provider Other Organization Name Type Code:
6
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:
1528058187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11527
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28220-1527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-522-1138
Provider Business Mailing Address Fax Number:
704-525-5106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5123A SOUTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-522-1138
Provider Business Practice Location Address Fax Number:
704-525-5106
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HILDRELTH
Authorized Official First Name:
JONNIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
V PRESIDENT
Authorized Official Telephone Number:
704-522-1138

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  7450 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0609575 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3440257 . This is a "NCPOP" identifier . This identifiers is of the category "OTHER".




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