Provider Demographics
NPI:1912741281
Name:JELKS FAMILY PHARMACY, LLC
Entity type:Organization
Organization Name:JELKS FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JELKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-890-6001
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0966
Mailing Address - Country:US
Mailing Address - Phone:601-890-6001
Mailing Address - Fax:601-890-6002
Practice Address - Street 1:1404 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MS
Practice Address - Zip Code:39631-4188
Practice Address - Country:US
Practice Address - Phone:601-890-6001
Practice Address - Fax:601-890-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy