Basic Information
| Provider Information | |||||||||
| NPI: | 1568460004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1970 ROANOKE BLVD | ||||||||
| Address2: | ATTN: PHARMACY DEPARTMENT | ||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241536404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409822463 | ||||||||
| FaxNumber: | 5408553478 | ||||||||
| Practice Location | |||||||||
| Address1: | 1970 ROANOKE BLVD | ||||||||
| Address2: | ATTN: PHARMACY DEPARTMENT | ||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241536404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409822463 | ||||||||
| FaxNumber: | 5408553478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1300X | 0202012130 | VA | N | Pharmacy Service Providers | Pharmacist | Psychiatric | 183500000X | 0202012130 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.