# JACKS ENTERPRISES-DOTHAN INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JACKS DRUGS-DOTHAN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215098033
- **Authorized official:** MATTHEW DIXON (BUSINESS MANAGER)
- **Authorized official phone:** (334) 836-0890

## Contact information

- **Practice address:** 1909 HONEYSUCKLE RD, DOTHAN, AL 36305-4289
- **Practice address phone:** (334) 836-0890
- **Practice address fax:** (334) 836-0894
- **Mailing address:** 1909 HONEYSUCKLE RD, DOTHAN, AL 36305-4289
- **Mailing address phone:** (334) 836-0890
- **Mailing address fax:** (334) 836-0894

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 112613 | AL | Yes |

## Other

- **Enumeration date:** 12/13/2006
- **Last updated:** 05/18/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0132857 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |
| 05 | — | 100003604 | — | AL |