Healthcare Provider Details

I. General information

NPI: 1265865745
Provider Name (Legal Business Name): KELLIE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 SPRING ST
PASO ROBLES CA
93446-1226
US

IV. Provider business mailing address

2424 SPRING ST
PASO ROBLES CA
93446-1226
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-3208
  • Fax: 805-239-1878
Mailing address:
  • Phone: 805-239-3208
  • Fax: 805-239-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: