Provider Demographics
NPI:1740216241
Name:JORDAN DRUG, INC.
Entity Type:Organization
Organization Name:JORDAN DRUG, INC.
Other - Org Name:VILLAGE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-464-3901
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0346
Mailing Address - Country:US
Mailing Address - Phone:606-464-3656
Mailing Address - Fax:606-464-9002
Practice Address - Street 1:1075 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9240
Practice Address - Country:US
Practice Address - Phone:606-464-3656
Practice Address - Fax:606-464-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
KYP013273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFLU0298OtherMEDICARE FLU
KY9006065800OtherDME MEDICAID
KY5403200800Medicaid
KY5403200800Medicaid