Provider Demographics
NPI:1770644866
Name:JACKS ENTERPRISES INC
Entity Type:Organization
Organization Name:JACKS ENTERPRISES INC
Other - Org Name:JACK'S DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:334-983-4191
Mailing Address - Street 1:15073 S US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:MIDLAND CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36350-6305
Mailing Address - Country:US
Mailing Address - Phone:334-983-4191
Mailing Address - Fax:334-983-5178
Practice Address - Street 1:15073 S US HIGHWAY 231
Practice Address - Street 2:MIDTOWN SHOPPING CENTER
Practice Address - City:MIDLAND CITY
Practice Address - State:AL
Practice Address - Zip Code:36350-6305
Practice Address - Country:US
Practice Address - Phone:334-983-4191
Practice Address - Fax:334-983-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
AL110399333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1993443OtherPK
AL100002671Medicaid