Provider Demographics
NPI:1144493008
Name:JONES, FREDERIC CLINTON (RPH)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:CLINTON
Last Name:JONES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12248 S IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-6154
Mailing Address - Country:US
Mailing Address - Phone:928-342-1327
Mailing Address - Fax:
Practice Address - Street 1:8151 E 32ND ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8401
Practice Address - Country:US
Practice Address - Phone:928-344-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ05888OtherPHARMACIST LICENSE