Provider Demographics
NPI:1508199654
Name:JONES, DAMON EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:EDWARD
Last Name:JONES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 NC HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075
Mailing Address - Country:US
Mailing Address - Phone:704-454-5920
Mailing Address - Fax:
Practice Address - Street 1:4305 NC HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075
Practice Address - Country:US
Practice Address - Phone:704-454-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16440183500000X
SC12416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0135892Medicaid