Organization
JORDAN DRUG, INC.
Active
Other names
Powell Prescription Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY C SMITH R. PH. (SEC/TREAS)
(606) 464-3901
Entity
Organization
Contact information
Practice address
4644 HIGHWAY 15 WEST, CLAY CITY, KY 40312
(606) 663-3481
(606) 663-4235
Mailing address
PO BOX 346, BEATTYVILLE, KY 41311-0346
(606) 464-3901
(606) 464-8888
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06458
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5403457400
—
KY
01
—
9000102500
DME MEDICAID
KY
01
—
FLU0298
MEDICARE FLU
KY
Enumeration date
06/27/2006
Last updated
05/08/2009
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