Provider Demographics
NPI:1265479778
Name:BRANDON JONES INC
Entity Type:Organization
Organization Name:BRANDON JONES INC
Other - Org Name:CLARK'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-840-1100
Mailing Address - Street 1:241 BILLY DYAR BLVD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-7102
Mailing Address - Country:US
Mailing Address - Phone:256-840-1100
Mailing Address - Fax:256-840-1119
Practice Address - Street 1:241 BILLY DYAR BLVD
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-7102
Practice Address - Country:US
Practice Address - Phone:256-840-1100
Practice Address - Fax:256-840-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1123833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145446OtherPK
AL157113Medicaid
7077580001Medicare NSC