MEDICARE: JONS 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	333600000X	Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	260017	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2046140	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194767798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONS DRUG INC

Provider Business Mailing Address
First Line	:	318 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-2774
Fax Number	:	218-744-5878

Provider Business Practice Location Address
First Line	:	318 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-2774
Fax Number	:	218-744-5878

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL MACACCINI
Credential	:	RPH
Telephone Number	:	218-744-2774

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	02/23/2017

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