Provider Demographics
NPI:1376607796
Name:JONES, KIMBERLY ISSAC (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ISSAC
Last Name:JONES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3016
Mailing Address - Country:US
Mailing Address - Phone:772-287-3443
Mailing Address - Fax:
Practice Address - Street 1:622 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3016
Practice Address - Country:US
Practice Address - Phone:772-287-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist