Healthcare Provider Details

I. General information

NPI: 1063051696
Provider Name (Legal Business Name): JUSTIN CLARK JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 JFK BLVD STE 5
NORTH LITTLE ROCK AR
72116-5397
US

IV. Provider business mailing address

516 E WOODRUFF AVE LOT B
SHERWOOD AR
72120-2667
US

V. Phone/Fax

Practice location:
  • Phone: 501-835-6530
  • Fax:
Mailing address:
  • Phone: 501-337-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD13653
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: