Provider Demographics
NPI:1265568745
Name:JONES DRUG STORE
Entity type:Organization
Organization Name:JONES DRUG STORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:870-475-2617
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:LEPANTO
Mailing Address - State:AR
Mailing Address - Zip Code:72354-0723
Mailing Address - Country:US
Mailing Address - Phone:870-475-2617
Mailing Address - Fax:870-475-2617
Practice Address - Street 1:216 GREENWOOD AVE SOUTH
Practice Address - Street 2:
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354
Practice Address - Country:US
Practice Address - Phone:870-475-2617
Practice Address - Fax:870-475-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR03953333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100345407Medicaid
AR0403953OtherNABP NUMBER
ARAR03953OtherARKANSAS STATE LICENSE NU
ARAR03953OtherARKANSAS STATE LICENSE NU