Provider Demographics
NPI:1114202991
Name:DAUGHERTY, JONAS BURNS (BS PHARM, RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:JONAS
Middle Name:BURNS
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:BS PHARM, RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 HAWKS NEST LANE
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572
Mailing Address - Country:US
Mailing Address - Phone:919-620-7557
Mailing Address - Fax:
Practice Address - Street 1:5116 NORTH ROXBORO ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-471-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist