Basic Information
| Provider Information | |||||||||
| NPI: | 1164618120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | TERESA | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1518 CASTLE DR | ||||||||
| Address2: | |||||||||
| City: | NORTH MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560031501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073822213 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1025 MARSH ST | ||||||||
| Address2: | |||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560014752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076254031 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2007 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 051037969 | IL | N | Pharmacy Service Providers | Pharmacist | 183500000X | 116326 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.