Provider Demographics
NPI:1093879017
Name:SHORES, JONATHAN ROY (RPH)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROY
Last Name:SHORES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 CHURCH ST
Mailing Address - Street 2:PLUSCARE PHARMACY
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1111
Mailing Address - Country:US
Mailing Address - Phone:989-872-2075
Mailing Address - Fax:989-872-5378
Practice Address - Street 1:6263 CHURCH ST
Practice Address - Street 2:PLUSCARE PHARMACY
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1111
Practice Address - Country:US
Practice Address - Phone:989-872-2075
Practice Address - Fax:989-872-5378
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist