Provider Demographics
NPI:1124024740
Name:PAUL JONES DRUG INC
Entity Type:Organization
Organization Name:PAUL JONES DRUG INC
Other - Org Name:PAUL JONES DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:580-225-2121
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-0467
Mailing Address - Country:US
Mailing Address - Phone:580-225-2121
Mailing Address - Fax:580-225-4216
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4751
Practice Address - Country:US
Practice Address - Phone:580-225-3263
Practice Address - Fax:580-225-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35-46673336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100233090AMedicaid
2072774OtherPK
OK100233090AMedicaid