Organization Name: | MT JACKSON DRUG STORE INC |
NPI Number: | 1346322120 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES FANSLER (PRESIDENT OWNER) |
Mailing Address: | 5350 Main St Mount Jackson |
State: | VA US |
Postal Code: | 228429511 |
Phone Number: | 5404773101 |
Fax Number: | 5404774039 |
NPI Enumeration Date: | 10/20/2006 |
NPI Last Update Date: | 04/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |