Provider Demographics
NPI:1841306735
Name:JONESBOROUGH DRUG
Entity type:Organization
Organization Name:JONESBOROUGH DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-753-5561
Mailing Address - Street 1:1003 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1538
Mailing Address - Country:US
Mailing Address - Phone:423-753-5571
Mailing Address - Fax:423-753-0550
Practice Address - Street 1:1003 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1538
Practice Address - Country:US
Practice Address - Phone:423-753-5571
Practice Address - Fax:423-753-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1171270001Medicare NSC