Jordan Drug, Inc.
Organization Active NPI Community/Retail Pharmacy · Jackson, KY
NPI 1689619348 · NPPES record last updated May 8, 2009
Key facts
- NPI
- 1689619348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- P06509 (KY)
- Legal business name
- JORDAN DRUG, INC.
- Practice address
- 842 Highway 15 North
Jackson, KY 41339-1017 - Phone
- (606) 666-7060
- Fax
- (606) 666-9454
- NPI assigned
- Jun 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Rosemayr C Smith, R. PH.
- Title
- Sec/Treas
- Phone
- (606) 464-3901
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 5
Practitioners 3
-
Deronda Kay Back, RPH
-
Jeremy Lee Price, PHARM D
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Jordan Drug Inc |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Wa… | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930048104 | KY | DME Supplier - Pharmacy |
5597764993 | Practice locations: Jackson, KY |
| O20150702001929 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 5597764993 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Booneville, KY; Jackson, KY; Clay City, KY; Campton, KY; Beattyville, KY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | |||
| Community/Retail Pharmacy | 3336C0003X | P06509 | KY | Yes |
Addresses
Primary practice location
842 Highway 15 North
Jackson, KY 41339-1017
Mailing address
PO Box 346
Beattyville, KY 41311-0346
Phone (606) 464-3901
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FLU0298 | Other | KY | MEDICARE FLU |
| 9000134800 | Other | KY | DME MEDICAID |
| 5400000500 | Medicaid | KY |
Other names
- Jackson Apothecary
Other providers in Jackson, KY
- John a Jones O.D., P.S.C.
- Aaron William Johnson
- Alexandria Erin Whitt Johnson
- Eunice Louise Johnson
- Tammy Jones
- Roger Joseph
- Juniper Health Inc
- Juniper Health Inc
- Juniper Health Inc
- Juniper Health Inc
All providers in Jackson, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.