Provider Demographics
NPI:1396032801
Name:PRANGE-JONES, MARY L (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:PRANGE-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 1:2707 SCHOFIELD AVE
Mailing Address - Street 2:T-0364
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2430
Mailing Address - Country:US
Mailing Address - Phone:715-355-1359
Mailing Address - Fax:
Practice Address - Street 1:2707 SCHOFIELD AVE
Practice Address - Street 2:T-0364
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2430
Practice Address - Country:US
Practice Address - Phone:715-355-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10205-40183500000X
FLPS35858183500000X
CO13685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist