MEDICARE: MRS. REBECCA JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	I057034	NY

General Provider Information

NPI Number	:	1942646401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA JONES

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12846-0310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	COR. BRIDGE AND MAIN ST
Second Line	:
City	:	LAKE LUZERNE
State	:	NY
Zip	:	12846-0310
Country	:	US
Telephone Number	:	518-696-3214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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