Provider Demographics
NPI:1467454629
Name:JARCO, INC.
Entity Type:Organization
Organization Name:JARCO, INC.
Other - Org Name:STRAUSER DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-468-6464
Mailing Address - Street 1:6 E SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1310
Mailing Address - Country:US
Mailing Address - Phone:573-468-6464
Mailing Address - Fax:573-468-5204
Practice Address - Street 1:6 E SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1310
Practice Address - Country:US
Practice Address - Phone:573-468-6464
Practice Address - Fax:573-468-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO018077333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600587802Medicaid
MO620587816Medicaid
MO2613986OtherNCPDP
MO000045126Medicare ID - Type UnspecifiedROSTER BILLING #