Healthcare Provider Details

I. General information

NPI: 1215854179
Provider Name (Legal Business Name): TREYVON DEMELL JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 IRVIN COBB DR
PADUCAH KY
42003-0338
US

IV. Provider business mailing address

9318 FERNHILL DR
LOUISVILLE KY
40291-1950
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-4885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021355
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: