Provider Demographics
NPI:1780016121
Name:BRISTOL, JONATHON JAUDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:JAUDON
Last Name:BRISTOL
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 1:1507 ASHEVILLE SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-5529
Mailing Address - Country:US
Mailing Address - Phone:704-880-1811
Mailing Address - Fax:
Practice Address - Street 1:590 RUSS AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2936
Practice Address - Country:US
Practice Address - Phone:828-452-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist