Provider Demographics
NPI:1619160736
Name:THE JEFFERSONS DRUG STORES INC
Entity Type:Organization
Organization Name:THE JEFFERSONS DRUG STORES INC
Other - Org Name:PEOPLES REXALL DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BADGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-246-9990
Mailing Address - Street 1:423 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9757
Mailing Address - Country:US
Mailing Address - Phone:336-246-9990
Mailing Address - Fax:336-246-6069
Practice Address - Street 1:423 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9757
Practice Address - Country:US
Practice Address - Phone:336-246-9990
Practice Address - Fax:336-246-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7701140332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701140Medicaid