Provider Demographics
NPI:1881705499
Name:J CO DRUG INC
Entity type:Organization
Organization Name:J CO DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRVEN
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:701-965-6671
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0050
Mailing Address - Country:US
Mailing Address - Phone:701-965-6671
Mailing Address - Fax:701-965-6849
Practice Address - Street 1:120 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730
Practice Address - Country:US
Practice Address - Phone:701-965-6671
Practice Address - Fax:701-965-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000213078Medicaid
ND020028Medicaid
3500469OtherNABP
3500469OtherNCPDP
ND020028Medicaid