MEDICARE: KRISTIE JONES R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	37881	TX

General Provider Information

NPI Number	:	1225648603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE JONES R.PH.

Provider Business Mailing Address
First Line	:	603 WALNUT BEND DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5844
Country	:	US
Telephone Number	:	817-637-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 W I 20
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3927
Country	:	US
Telephone Number	:	972-660-1527
Fax Number	:	972-660-3869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	07/31/2020

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