Provider Demographics
NPI:1467662858
Name:JONES, MARSHALL VANCE JR (RPH)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:VANCE
Last Name:JONES
Suffix:JR
Gender:M
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:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-0083
Mailing Address - Country:US
Mailing Address - Phone:731-420-0158
Mailing Address - Fax:901-386-8476
Practice Address - Street 1:9025 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-8448
Practice Address - Country:US
Practice Address - Phone:901-383-2265
Practice Address - Fax:901-386-8476
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC5120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist