Provider Demographics
NPI:1427384031
Name:JONES, IVANETTA MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:IVANETTA
Middle Name:MICHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4102
Mailing Address - Country:US
Mailing Address - Phone:817-473-8674
Mailing Address - Fax:817-453-3510
Practice Address - Street 1:8100 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4102
Practice Address - Country:US
Practice Address - Phone:817-473-8674
Practice Address - Fax:817-453-3510
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist