Provider Demographics
NPI:1235436544
Name:JONES, KELLY AMANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:AMANDA
Last Name:JONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 N JEFFERIES BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2733
Mailing Address - Country:US
Mailing Address - Phone:843-549-6781
Mailing Address - Fax:843-549-9642
Practice Address - Street 1:1326 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2733
Practice Address - Country:US
Practice Address - Phone:843-549-6781
Practice Address - Fax:843-549-9642
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist