Provider Demographics
NPI:1588983076
Name:JONES, CORNELL H JR
Entity type:Individual
Prefix:
First Name:CORNELL
Middle Name:H
Last Name:JONES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 KECOUGHTAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4405
Mailing Address - Country:US
Mailing Address - Phone:757-728-2913
Mailing Address - Fax:757-728-3886
Practice Address - Street 1:3701 KECOUGHTAN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4405
Practice Address - Country:US
Practice Address - Phone:757-728-2913
Practice Address - Fax:757-728-3886
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist