Provider Demographics
NPI:1134874290
Name:JONES DRUG STORE P.C.
Entity type:Organization
Organization Name:JONES DRUG STORE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:405-742-8099
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-7586
Mailing Address - Country:US
Mailing Address - Phone:405-399-2277
Mailing Address - Fax:405-399-3277
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-7586
Practice Address - Country:US
Practice Address - Phone:405-399-2277
Practice Address - Fax:405-399-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1-9139OtherOKLAHOMA STATE BOARD OF PHARMACY