Provider Demographics
NPI:1174650949
Name:JAMISON DRUG CENTERS INC
Entity Type:Organization
Organization Name:JAMISON DRUG CENTERS INC
Other - Org Name:FAULKNER'S DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-283-8131
Mailing Address - Street 1:215 E JEFFERSON ST
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4865
Mailing Address - Country:US
Mailing Address - Phone:704-283-8131
Mailing Address - Fax:704-289-1954
Practice Address - Street 1:215 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4865
Practice Address - Country:US
Practice Address - Phone:704-283-8131
Practice Address - Fax:704-289-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0905331Medicaid
NC0905331Medicaid