Provider Demographics
NPI:1326495094
Name:JONES PHARMACY INC
Entity Type:Organization
Organization Name:JONES PHARMACY INC
Other - Org Name:STRAWBERRY HILLS PHARMACY SOUTHSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-408-3784
Mailing Address - Street 1:PO BOX 9245
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9245
Mailing Address - Country:US
Mailing Address - Phone:270-408-3784
Mailing Address - Fax:270-408-3785
Practice Address - Street 1:3837 CLARKS RIVER RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-0802
Practice Address - Country:US
Practice Address - Phone:270-408-3784
Practice Address - Fax:270-408-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP077703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100414590Medicaid
2160711OtherPK