MEDICARE: PAUL JONES DRUG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	35-4667	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2072774	OTHER		PK

General Provider Information

NPI Number	:	1124024740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL JONES DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 467
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73648-0467
Country	:	US
Telephone Number	:	580-225-2121
Fax Number	:	580-225-4216

Provider Business Practice Location Address
First Line	:	105 N MAIN ST
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4751
Country	:	US
Telephone Number	:	580-225-3263
Fax Number	:	580-225-4216

Authorized Official
Title or Position	:	OWNER
Name	:	GINA MEADOR
Credential	:	RPH
Telephone Number	:	580-225-2121

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/02/2014

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Directions to “PAUL JONES DRUG INC ” Practice Location

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