Provider Demographics
NPI:1770956427
Name:JONES, JUSTIN (CPHT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:CPHT
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 326
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:VT
Mailing Address - Zip Code:05038-0326
Mailing Address - Country:US
Mailing Address - Phone:802-685-0073
Mailing Address - Fax:802-685-0082
Practice Address - Street 1:356 VT ROUTE 110
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:VT
Practice Address - Zip Code:05038
Practice Address - Country:US
Practice Address - Phone:802-685-0073
Practice Address - Fax:802-685-0082
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT121.0001811183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT520107010075OtherPTCB