Healthcare Provider Details

I. General information

NPI: 1720175342
Provider Name (Legal Business Name): JONES AND CLAYTON DRUGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BUCHANAN ST N
BREMEN GA
30110-1606
US

IV. Provider business mailing address

116 BUCHANAN ST N
BREMEN GA
30110-1606
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-2364
  • Fax: 770-537-3032
Mailing address:
  • Phone: 770-537-2364
  • Fax: 770-537-3032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE005152
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE005152
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHRE005152
License Number StateGA

VIII. Authorized Official

Name: DR. JOSEPH CAMERON ENTREKIN
Title or Position: PRESIDENT/PHARMACIST
Credential: PHARM.D., CDM
Phone: 770-537-2364