Provider Demographics
NPI:1942642814
Name:JONES COUNTY DRUG INC
Entity Type:Organization
Organization Name:JONES COUNTY DRUG INC
Other - Org Name:JONES COUNTY DRUG INC,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-477-3030
Mailing Address - Street 1:407 HILL ST
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-2523
Mailing Address - Country:US
Mailing Address - Phone:601-477-3030
Mailing Address - Fax:601-477-3131
Practice Address - Street 1:407 HILL ST
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2523
Practice Address - Country:US
Practice Address - Phone:601-477-3030
Practice Address - Fax:601-477-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS124833336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154999OtherPK
MS02459747Medicaid