Provider Demographics
NPI:1164980280
Name:JONES, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
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 1:621 N HAMPTON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4513
Mailing Address - Country:US
Mailing Address - Phone:469-747-3171
Mailing Address - Fax:469-747-3172
Practice Address - Street 1:621 N HAMPTON RD STE 108
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4513
Practice Address - Country:US
Practice Address - Phone:469-747-3171
Practice Address - Fax:469-747-3172
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist