=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174691810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JONES DRUG COMPANY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 03/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2729 E SPEEDWAY
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85716-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-318-4421
-----------------------------------------------------
Fax | 520-318-1054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2729 E SPEEDWAY BLVD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85716-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-318-4421
-----------------------------------------------------
Fax | 520-318-1054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RPH OWNER
-----------------------------------------------------
Name | THOMAS C REED
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 520-318-4421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 0314840002
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | NABP0322886
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | Y02967
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------