Provider Demographics
NPI:1184640369
Name:JACKSON DRUG CO., INC
Entity Type:Organization
Organization Name:JACKSON DRUG CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-857-2731
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-0120
Mailing Address - Country:US
Mailing Address - Phone:706-857-2731
Mailing Address - Fax:706-857-1773
Practice Address - Street 1:10077 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1356
Practice Address - Country:US
Practice Address - Phone:706-857-2731
Practice Address - Fax:706-857-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0041843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy