Provider Demographics
NPI:1770838195
Name:JONES, MATTHEW BRIAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRIAN
Last Name:JONES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 N SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5359
Mailing Address - Country:US
Mailing Address - Phone:479-443-5628
Mailing Address - Fax:479-439-6363
Practice Address - Street 1:3545 N SHILOH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5359
Practice Address - Country:US
Practice Address - Phone:479-443-5628
Practice Address - Fax:479-439-6363
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD12001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist