Provider Demographics
NPI:1982749982
Name:JARCO PHARMACIES, INC.
Entity Type:Organization
Organization Name:JARCO PHARMACIES, INC.
Other - Org Name:LINN DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBROAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEAVENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-227-7811
Mailing Address - Street 1:2100 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1734
Mailing Address - Country:US
Mailing Address - Phone:918-858-4619
Mailing Address - Fax:918-592-4585
Practice Address - Street 1:304 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-9000
Practice Address - Country:US
Practice Address - Phone:573-897-4140
Practice Address - Fax:573-897-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004340332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO624952800OtherMEDICAID DME
MO600587828Medicaid
MO600587828Medicaid