MEDICARE: JORDAN 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	3336C0003X	Community/Retail Pharmacy	P01464	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	FLU0298	OTHER	KY	MEDICARE FLU

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205862836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN DRUG, INC.

Provider Business Mailing Address
First Line	:	PO BOX 346
Second Line	:
City	:	BEATTYVILLE
State	:	KY
Zip	:	41311-0346
Country	:	US
Telephone Number	:	606-464-3901
Fax Number	:	606-464-8888

Provider Business Practice Location Address
First Line	:	820 HWY 11 NORTH
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314
Country	:	US
Telephone Number	:	606-593-6306
Fax Number	:	606-593-6859

Authorized Official
Title or Position	:	SEC/TREAS
Name	:	ROSEMARY C SMITH
Credential	:	R. PH.
Telephone Number	:	606-464-3901

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	09/21/2015

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Directions to “JORDAN DRUG, INC. ” Practice Location

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