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General NPI Number Information
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NPI Number | 1215098033
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Entity Type | Organization
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Legal Business Name | JACKS ENTERPRISES-DOTHAN INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 1909 HONEYSUCKLE RD
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City | DOTHAN
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State | AL
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Zip | 36305-4289
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Country | US
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Telephone | 334-836-0890
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Fax | 334-836-0894
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Provider Business Mailing Address
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Address Line | 1909 HONEYSUCKLE RD
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City | DOTHAN
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State | AL
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Zip | 36305-4289
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Country | US
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Telephone | 334-836-0890
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Fax | 334-836-0894
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | KENNETH FLOYD
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Credential |
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Telephone | 334-836-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 112613
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License Number State | AL
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