Provider Demographics
NPI:1366623514
Name:JONES, KIZZIE LASHEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIZZIE
Middle Name:LASHEA
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 1:119 W 132ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7801
Mailing Address - Country:US
Mailing Address - Phone:347-767-8274
Mailing Address - Fax:
Practice Address - Street 1:2170 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1149
Practice Address - Country:US
Practice Address - Phone:212-666-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664684Medicaid