Provider Demographics
NPI:1760772636
Name:JONES, NICHOLAS A (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 N FRANCISCO AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2743
Mailing Address - Country:US
Mailing Address - Phone:773-292-8260
Mailing Address - Fax:773-292-8321
Practice Address - Street 1:1044 N FRANCISCO AVE
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2743
Practice Address - Country:US
Practice Address - Phone:773-292-8260
Practice Address - Fax:773-292-8321
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist