Provider Demographics
NPI:1457662231
Name:JONES, TRUDY ANN (DPH)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BEACON LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3762
Mailing Address - Country:US
Mailing Address - Phone:901-355-0966
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:630B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-821-8330
Practice Address - Fax:901-821-8350
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC7383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist