Provider Demographics
NPI:1043594211
Name:JONES, MARK D
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WAR MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:61616-7723
Mailing Address - Country:US
Mailing Address - Phone:309-682-3844
Mailing Address - Fax:
Practice Address - Street 1:1200 WAR MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-7723
Practice Address - Country:US
Practice Address - Phone:309-682-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist