Provider Demographics
NPI:1649994351
Name:JONES DRUG STORE INC
Entity type:Organization
Organization Name:JONES DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-238-4177
Mailing Address - Street 1:125 COURT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1807
Mailing Address - Country:US
Mailing Address - Phone:573-243-3524
Mailing Address - Fax:573-243-2155
Practice Address - Street 1:125 COURT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1807
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:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600130504Medicaid