Healthcare Provider Details

I. General information

NPI: 1902832173
Provider Name (Legal Business Name): JORDAN DRUG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MOUNTAIN PARKWAY SPUR
CAMPTON KY
41301-8988
US

IV. Provider business mailing address

PO BOX 346
BEATTYVILLE KY
41311-0346
US

V. Phone/Fax

Practice location:
  • Phone: 606-668-3900
  • Fax: 606-668-3925
Mailing address:
  • Phone: 606-464-3901
  • Fax: 606-464-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06638
License Number StateKY

VIII. Authorized Official

Name: ROSEMARY C SMITH
Title or Position: SEC/TREAS
Credential: R. PH.
Phone: 606-464-3901