Provider Demographics
NPI:1578749313
Name:JONES, EDDIE CLARK (REG PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:CLARK
Last Name:JONES
Suffix:
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 W OCALA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-8231
Mailing Address - Country:US
Mailing Address - Phone:918-455-1042
Mailing Address - Fax:918-455-1042
Practice Address - Street 1:1416 W OCALA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-8231
Practice Address - Country:US
Practice Address - Phone:918-455-1042
Practice Address - Fax:918-455-1042
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist