Organization
JACKSON DRUG CO
Active
Other names
JACKSON DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE EDLIN RPH (OWNER)
(507) 847-3161
Entity
Organization
Contact information
Practice address
506 2ND ST, JACKSON, MN 56143-0233
(507) 847-3161
(507) 847-2480
Mailing address
506 2ND ST, JACKSON, MN 56143-0233
(507) 847-3461
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
22124900
MN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2405632
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/20/2007
Last updated
08/13/2007
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