MEDICARE: JONES DRUG STORE 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	332B00000X	Durable Medical Equipment & Medical Supplies	10119701	MO

General Provider Information

NPI Number	:	1174528293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONES DRUG STORE INC

Provider Business Mailing Address
First Line	:	125 COURT ST
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1807
Country	:	US
Telephone Number	:	573-243-3524
Fax Number	:	573-243-2366

Provider Business Practice Location Address
First Line	:	125 COURT ST
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1807
Country	:	US
Telephone Number	:	573-243-3524
Fax Number	:	573-243-2366

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. THOMAS E BROCKETT
Credential	:	R.P.H.
Telephone Number	:	573-243-3524

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	08/22/2020

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Directions to “JONES DRUG STORE INC ” Practice Location

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