Provider Demographics
NPI:1215297825
Name:JONES, WILLIAM WALLACE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WALLACE
Last Name:JONES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:W
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:338 HOWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-7928
Mailing Address - Country:US
Mailing Address - Phone:252-223-3291
Mailing Address - Fax:252-223-2191
Practice Address - Street 1:338 HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-7928
Practice Address - Country:US
Practice Address - Phone:252-223-3291
Practice Address - Fax:252-223-2191
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist