Provider Demographics
NPI:1689891863
Name:JONES, BRUCE H
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BARRY
Mailing Address - State:IL
Mailing Address - Zip Code:62312-1392
Mailing Address - Country:US
Mailing Address - Phone:217-335-3095
Mailing Address - Fax:
Practice Address - Street 1:436 N 30TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3602
Practice Address - Country:US
Practice Address - Phone:217-224-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist