Provider Demographics
NPI:1528058187
Name:JONES PHARMACY ENTERPRISES INC
Entity type:Organization
Organization Name:JONES PHARMACY ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JONNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILDRELTH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:704-522-1138
Mailing Address - Street 1:PO BOX 11527
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28220-1527
Mailing Address - Country:US
Mailing Address - Phone:704-522-1138
Mailing Address - Fax:704-525-5106
Practice Address - Street 1:5123A SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2709
Practice Address - Country:US
Practice Address - Phone:704-522-1138
Practice Address - Fax:704-525-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7450333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609575Medicaid
3440257OtherNCPOP