Provider Demographics
NPI:1215367974
Name:JONES, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 INVERRARY DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5756
Mailing Address - Country:US
Mailing Address - Phone:228-326-7254
Mailing Address - Fax:
Practice Address - Street 1:650 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3921
Practice Address - Country:US
Practice Address - Phone:850-747-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-17
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist