Healthcare Provider Details

I. General information

NPI: 1124024740
Provider Name (Legal Business Name): PAUL JONES DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N MAIN ST
ELK CITY OK
73644-4751
US

IV. Provider business mailing address

PO BOX 467
ELK CITY OK
73648-0467
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-3263
  • Fax: 580-225-4216
Mailing address:
  • Phone: 580-225-2121
  • Fax: 580-225-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number35-4667
License Number StateOK

VIII. Authorized Official

Name: GINA MEADOR
Title or Position: OWNER
Credential: RPH
Phone: 580-225-2121