Provider Demographics
NPI:1902141344
Name:JONES, MARY JANE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:JONES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 156
Mailing Address - Street 2:610 W. ADAMS ST
Mailing Address - City:BLACK RIVER FALLS,
Mailing Address - State:WI
Mailing Address - Zip Code:54615
Mailing Address - Country:US
Mailing Address - Phone:715-284-4089
Mailing Address - Fax:715-284-1606
Practice Address - Street 1:610 WEST ADAMS ST.
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS,
Practice Address - State:WI
Practice Address - Zip Code:54615
Practice Address - Country:US
Practice Address - Phone:715-284-4089
Practice Address - Fax:715-284-1606
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist