Healthcare Provider Details

I. General information

NPI: 1265479778
Provider Name (Legal Business Name): BRANDON JONES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 BILLY DYAR BLVD
BOAZ AL
35957-7102
US

IV. Provider business mailing address

241 BILLY DYAR BLVD
BOAZ AL
35957-7102
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-1100
  • Fax: 256-840-1119
Mailing address:
  • Phone: 256-840-1100
  • Fax: 256-840-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112383
License Number StateAL

VIII. Authorized Official

Name: BRANDON JONES
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 256-840-1100