=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114366689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERI ELLIS JONES PHARM.D,RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2013
-----------------------------------------------------
Last Update Date | 06/18/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 N CENTER ST
-----------------------------------------------------
City | MOUNT OLIVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28365-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-635-0011
-----------------------------------------------------
Fax | 919-635-1311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 N CENTER ST
-----------------------------------------------------
City | MOUNT OLIVE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28365-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-635-0011
-----------------------------------------------------
Fax | 919-635-1311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10998
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------