Provider Demographics
NPI:1902961113
Name:C MICHAEL JONES MDPC
Entity Type:Organization
Organization Name:C MICHAEL JONES MDPC
Other - Org Name:JONES PROFESSIONAL BLDG PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM MGR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:901-685-5969
Mailing Address - Street 1:7710 WOLF RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1734
Mailing Address - Country:US
Mailing Address - Phone:901-685-5969
Mailing Address - Fax:901-665-6424
Practice Address - Street 1:7710 WOLF RIVER CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1734
Practice Address - Country:US
Practice Address - Phone:901-685-5969
Practice Address - Fax:901-665-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000035903336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4434798AMedicaid
4434798OtherNCPDP PROVIDER IDENTIFICATION NUMBER