Provider Demographics
NPI:1134163520
Name:JONES, REGINALD R (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:1248 MAIN STREET
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-0410
Mailing Address - Country:US
Mailing Address - Phone:256-638-6667
Mailing Address - Fax:256-638-6658
Practice Address - Street 1:1248 MAIN ST
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971-3471
Practice Address - Country:US
Practice Address - Phone:256-638-6667
Practice Address - Fax:256-638-6658
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003112Medicaid