Provider Demographics
NPI:1891897815
Name:JONES DRUG STORE INC
Entity Type:Organization
Organization Name:JONES DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-243-3525
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:125 COURT STREET
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-243-3524
Mailing Address - Fax:573-243-2155
Practice Address - Street 1:125 COURT STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755
Practice Address - Country:US
Practice Address - Phone:573-243-3524
Practice Address - Fax:573-243-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10119701183500000X, 332B00000X
MO0055863336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600130504Medicaid
MO620130500Medicaid
MO600130504Medicaid