Provider Demographics
NPI:1366448003
Name:JOKEN INC
Entity Type:Organization
Organization Name:JOKEN INC
Other - Org Name:JOBE DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-845-2577
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-2716
Mailing Address - Country:US
Mailing Address - Phone:903-845-2577
Mailing Address - Fax:903-845-1104
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-2716
Practice Address - Country:US
Practice Address - Phone:903-845-2577
Practice Address - Fax:903-845-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140882Medicaid
TX140882Medicaid