Provider Demographics
NPI:1114212586
Name:JONES, AMY ELISABETH (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELISABETH
Last Name:JONES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 W 78TH ST
Mailing Address - Street 2:T-0862
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9579
Mailing Address - Country:US
Mailing Address - Phone:952-470-1006
Mailing Address - Fax:952-277-1006
Practice Address - Street 1:851 W 78TH ST
Practice Address - Street 2:T-0862
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9579
Practice Address - Country:US
Practice Address - Phone:952-470-1006
Practice Address - Fax:952-277-1006
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist