Provider Demographics
NPI:1457315640
Name:JEFFERSON DRUG COMPANY, INC.
Entity Type:Organization
Organization Name:JEFFERSON DRUG COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-367-5221
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:23 LEE STREET
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-0463
Mailing Address - Country:US
Mailing Address - Phone:706-367-5221
Mailing Address - Fax:706-367-4036
Practice Address - Street 1:23 LEE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1345
Practice Address - Country:US
Practice Address - Phone:706-367-5221
Practice Address - Fax:706-367-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0002929895AMedicaid
GA0002929895AMedicaid