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General NPI Number Information
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NPI Number | 1194765164
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Entity Type | Individual
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Provider Name | MARY LISA JONES RPH
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Gender | Female
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 2 MEMORIAL DRIVE STE 100, HOME CARE PHARMACY
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City | ALTON
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State | IL
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Zip | 62002-6723
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Country | US
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Telephone | 618-463-7865
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Fax | 618-463-7884
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Provider Business Mailing Address
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Address Line | 1 MEMORIAL DR RM G247
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City | ALTON
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State | IL
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Zip | 62002-6722
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Country | US
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Telephone | 618-463-7866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 042002
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051035894
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License Number State | IL
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