Provider Demographics
NPI:1205862836
Name:JORDAN DRUG, INC.
Entity Type:Organization
Organization Name:JORDAN DRUG, INC.
Other - Org Name:OWSLEY PRESCRIPTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:606-464-3901
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0346
Mailing Address - Country:US
Mailing Address - Phone:606-464-3901
Mailing Address - Fax:606-464-8888
Practice Address - Street 1:820 HWY 11 NORTH
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314
Practice Address - Country:US
Practice Address - Phone:606-593-6306
Practice Address - Fax:606-593-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
KYP014643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5403203200Medicaid
KY9003095800OtherDME MEDICAID
KYFLU0298OtherMEDICARE FLU
KY5403203200Medicaid