Provider Demographics
NPI:1255634374
Name:JONES, WARREN RICKMAN (RPH)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:RICKMAN
Last Name:JONES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 HILLSBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3008
Mailing Address - Country:US
Mailing Address - Phone:919-384-9560
Mailing Address - Fax:919-384-9719
Practice Address - Street 1:3457 HILLSBOROUGH RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3008
Practice Address - Country:US
Practice Address - Phone:919-384-9560
Practice Address - Fax:919-384-9719
Is Sole Proprietor?:No
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326495Medicaid