Provider Demographics
NPI:1649554999
Name:JONES, WILLIAM OTTIS (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:OTTIS
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 1:10393 CYPRESS LAKES DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3645
Mailing Address - Country:US
Mailing Address - Phone:904-386-4931
Mailing Address - Fax:
Practice Address - Street 1:4901 GATE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4405
Practice Address - Country:US
Practice Address - Phone:904-997-7002
Practice Address - Fax:904-997-7009
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS14535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist