Provider Demographics
NPI:1699943605
Name:JONES, TIMOTHY ALLEN SR (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:JONES
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROOKS AVE
Mailing Address - Street 2:ATTN: PHARMACY OFFICE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3512
Mailing Address - Country:US
Mailing Address - Phone:585-239-2020
Mailing Address - Fax:585-239-2015
Practice Address - Street 1:4722 ONONDAGA BLVD
Practice Address - Street 2:ATTN: PHARMACY MANAGER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3304
Practice Address - Country:US
Practice Address - Phone:315-478-0780
Practice Address - Fax:315-478-1680
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039456OtherRPH LICENSE