Provider Demographics
NPI:1689866279
Name:JONES PHARMACY ENTERPRISES, INC.
Entity Type:Organization
Organization Name:JONES PHARMACY ENTERPRISES, INC.
Other - Org Name:GIANT GENIE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:HARTLEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-525-2704
Mailing Address - Street 1:5123 SOUTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2754
Mailing Address - Country:US
Mailing Address - Phone:704-525-3956
Mailing Address - Fax:704-525-3978
Practice Address - Street 1:5123 SOUTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2754
Practice Address - Country:US
Practice Address - Phone:704-525-3956
Practice Address - Fax:704-525-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC041953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC069948Medicaid
NC2779627OtherMASS IMMUNIZER
NC0168150001Medicare NSC