Organization
PEJ INC
Active
Organization
PEJ INC
Active
Other names
FAMILY PHARMACY OF JACKSON
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EVERETT L DUNAWAY RPH. (OWNER)
(606) 666-5519
Entity
Organization
Contact information
Practice address
265 HWY 15 S SUITE 2, JACKSON, KY 41339
(606) 666-5519
(606) 666-9371
Mailing address
265 HWY 15 S SUITE 2, JACKSON, KY 41339
(606) 666-5519
(606) 666-9371
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P06562
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54000500
—
KY
01
—
90001389
MEDICAID DME
KY
Enumeration date
02/05/2007
Last updated
07/29/2008
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