Provider Demographics
NPI:1043601560
Name:JAMESTOWN FAMILY PHARMACY INC
Entity type:Organization
Organization Name:JAMESTOWN FAMILY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-595-6979
Mailing Address - Street 1:2905 DARROW RD
Mailing Address - Street 2:WALKERTOWN FAMILY PHARMACY
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051
Mailing Address - Country:US
Mailing Address - Phone:336-595-6979
Mailing Address - Fax:336-595-7079
Practice Address - Street 1:2905 DARROW RD
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9682
Practice Address - Country:US
Practice Address - Phone:336-595-6979
Practice Address - Fax:336-595-7079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health