Provider Demographics
NPI:1245954148
Name:JONES, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
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:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-1017
Mailing Address - Country:US
Mailing Address - Phone:434-946-2702
Mailing Address - Fax:434-946-0025
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-3201
Practice Address - Country:US
Practice Address - Phone:434-946-2702
Practice Address - Fax:434-946-0025
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022199323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy