Provider Demographics
NPI:1285706069
Name:G AND M PHARMACY INC
Entity type:Organization
Organization Name:G AND M PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:JETT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:870-935-1340
Mailing Address - Street 1:325 SOUTHWEST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5854
Mailing Address - Country:US
Mailing Address - Phone:870-935-1340
Mailing Address - Fax:870-935-3328
Practice Address - Street 1:325 SOUTHWEST DR
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5854
Practice Address - Country:US
Practice Address - Phone:870-935-1340
Practice Address - Fax:870-935-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AR04172053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0417205OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR100869407Medicaid
AR100869407Medicaid