Provider Demographics
NPI:1649334947
Name:JONES, NICOLE B (RPH)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:B
Last Name:JONES
Suffix:
Gender:F
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:AL
Mailing Address - Zip Code:35747-0037
Mailing Address - Country:US
Mailing Address - Phone:256-728-4217
Mailing Address - Fax:
Practice Address - Street 1:5421 MAIN ST
Practice Address - Street 2:GRANT PHARMACY
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747-8322
Practice Address - Country:US
Practice Address - Phone:256-728-4217
Practice Address - Fax:256-728-5603
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist