Provider Demographics
NPI:1194765164
Name:JONES, MARY LISA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LISA
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 1:1 MEMORIAL DR RM G247
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6722
Mailing Address - Country:US
Mailing Address - Phone:618-463-7866
Mailing Address - Fax:
Practice Address - Street 1:2 MEMORIAL DRIVE
Practice Address - Street 2:STE 100, HOME CARE PHARMACY
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-463-7865
Practice Address - Fax:618-463-7884
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042002183500000X
IL051035894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist