Provider Demographics
NPI:1639280407
Name:JONES, LEOLA (RPH)
Entity Type:Individual
Prefix:
First Name:LEOLA
Middle Name:
Last Name: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 1:1959 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2005
Mailing Address - Country:US
Mailing Address - Phone:773-643-4200
Mailing Address - Fax:773-643-9432
Practice Address - Street 1:1959 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2005
Practice Address - Country:US
Practice Address - Phone:773-643-4200
Practice Address - Fax:773-643-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0540410001Medicare NSC