Provider Demographics
NPI:1073159471
Name:JONES, TODD JASON (RPH)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:JASON
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 1:715 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4526
Mailing Address - Country:US
Mailing Address - Phone:765-213-1220
Mailing Address - Fax:765-213-1225
Practice Address - Street 1:715 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4526
Practice Address - Country:US
Practice Address - Phone:765-213-1220
Practice Address - Fax:765-213-1225
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018616A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist