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General NPI Number Information
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NPI Number | 1689619348
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Entity Type | Organization
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Legal Business Name | JORDAN DRUG, INC.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 842 HIGHWAY 15 NORTH
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City | JACKSON
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State | KY
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Zip | 41339-1017
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Country | US
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Telephone | 606-666-7060
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Fax | 606-666-9454
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Provider Business Mailing Address
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Address Line | PO BOX 346
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City | BEATTYVILLE
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State | KY
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Zip | 41311-0346
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Country | US
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Telephone | 606-464-3901
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Fax | 606-464-8888
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Authorized Official
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Title or Position | SEC/TREAS
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Name | ROSEMAYR C SMITH
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Credential | R. PH.
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Telephone | 606-464-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P06509
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License Number State | KY
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