Provider Demographics
NPI:1366421687
Name:JONES, HAROLD RUSSELL
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:RUSSELL
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:RUSSELL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:31 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3336
Mailing Address - Country:US
Mailing Address - Phone:732-741-1191
Mailing Address - Fax:732-530-5603
Practice Address - Street 1:601 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5906
Practice Address - Country:US
Practice Address - Phone:732-222-5400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01393900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist