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General NPI Number Information
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NPI Number | 1902141344
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Entity Type | Individual
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Provider Name | MARY JANE JONES RPH
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Gender | Female
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 610 WEST ADAMS ST.
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615
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Country | US
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Telephone | 715-284-4089
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Fax | 715-284-1606
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Provider Business Mailing Address
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Address Line | P.O. BOX 156 610 W. ADAMS ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615
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Country | US
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Telephone | 715-284-4089
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Fax | 715-284-1606
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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 | 8350
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License Number State | WI
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