Basic Information
Provider Information
NPI: 1003141938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: DURWOOD
MiddleName: RAY
NamePrefix: MR.
NameSuffix:  
Credential: B. S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2802 FAIRFAX ROAD
Address2:  
City: KINSTON
State: NC
PostalCode: 285041153
CountryCode: US
TelephoneNumber: 2525221378
FaxNumber:  
Practice Location
Address1: 2201 NORTH HERRITAGE STREET
Address2:  
City: KINSTON
State: NC
PostalCode: 28501
CountryCode: US
TelephoneNumber: 2525224902
FaxNumber: 2522081365
Other Information
ProviderEnumerationDate: 10/09/2009
LastUpdateDate: 10/09/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X06277NCY Pharmacy Service ProvidersPharmacist 

No ID Information.


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