Individual provider Active NPI

Mary Lisa Jones, RPH

  • Pharmacist
  • Alton, IL
National Provider Identifier
1194765164
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051035894 Issued in IL
Practice address
2 Memorial Drive
Ste 100, Home Care Pharmacy
Alton, IL 62002-6723
Phone
(618) 463-7865
Fax
(618) 463-7884
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 042002 MO
Pharmacist 183500000X 051035894 IL Primary

Addresses

Primary practice location

2 Memorial Drive
Ste 100, Home Care Pharmacy
Alton, IL 62002-6723

Mailing address

1 Memorial Dr RM G247
Alton, IL 62002-6722
Phone (618) 463-7866

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
051035894ILMDPharmacist
042002MOMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1194765164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEMORIAL DR RM G247",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026722",
            "telephone_number": "618-463-7866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEMORIAL DRIVE",
            "address_2": "STE 100, HOME CARE PHARMACY",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026723",
            "telephone_number": "618-463-7865",
            "fax_number": "618-463-7884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "MARY",
        "middle_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "042002",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051035894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.