Provider Demographics
NPI:1760754642
Name:JONES, KEVIN W (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1911
Mailing Address - Country:US
Mailing Address - Phone:570-474-9203
Mailing Address - Fax:570-474-0363
Practice Address - Street 1:237 S MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1911
Practice Address - Country:US
Practice Address - Phone:570-474-9203
Practice Address - Fax:570-474-0363
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041011L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist