Provider Demographics
NPI:1225679731
Name:JONES, CHARLES WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WAYNE
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 1:815 NICOLE CT
Mailing Address - Street 2:
Mailing Address - City:BONNE TERRE
Mailing Address - State:MO
Mailing Address - Zip Code:63628-9364
Mailing Address - Country:US
Mailing Address - Phone:479-531-5019
Mailing Address - Fax:
Practice Address - Street 1:707 WALTON DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1953
Practice Address - Country:US
Practice Address - Phone:573-756-8677
Practice Address - Fax:573-756-8701
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130088131835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist