Provider Demographics
NPI:1710193669
Name:JONES, AMY KELLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KELLER
Last Name:JONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELLEN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5953 TERRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2148
Practice Address - Country:US
Practice Address - Phone:562-682-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58717183500000X
NC19244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist