Provider Demographics
NPI:1790794162
Name:TOM JONES DISCOUNT DRUG CENTER INC
Entity Type:Organization
Organization Name:TOM JONES DISCOUNT DRUG CENTER INC
Other - Org Name:TOM JONES DRUG DISCOUNT DRUG CENTER OF GARNER INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-772-4737
Mailing Address - Street 1:101 TIMBER POINTE LN
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2511
Mailing Address - Country:US
Mailing Address - Phone:919-772-4737
Mailing Address - Fax:919-772-0375
Practice Address - Street 1:101 TIMBER POINTE LN
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2511
Practice Address - Country:US
Practice Address - Phone:919-772-4737
Practice Address - Fax:919-772-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0406AOtherBCBS OF NC
NC7700183Medicaid
NC=========OtherTAX ID NUMBER
NC7700183Medicaid