Provider Demographics
NPI:1821316480
Name:JONES, WESLEY ALAN
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:ALAN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-5642
Mailing Address - Country:US
Mailing Address - Phone:254-968-8887
Mailing Address - Fax:
Practice Address - Street 1:2150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3928
Practice Address - Country:US
Practice Address - Phone:254-965-2267
Practice Address - Fax:254-965-0832
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist