Provider Demographics
NPI:1154926764
Name:JONES, CASSANDRA K
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6486 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3315
Mailing Address - Country:US
Mailing Address - Phone:757-561-5378
Mailing Address - Fax:
Practice Address - Street 1:9555 KINGS CHARTER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-7994
Practice Address - Country:US
Practice Address - Phone:800-753-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27409183500000X
VA0202217992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist