Provider Demographics
NPI:1295011963
Name:SHINKONIS, GERALD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:SHINKONIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26055 MARTINDALE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9736
Mailing Address - Country:US
Mailing Address - Phone:248-890-2699
Mailing Address - Fax:
Practice Address - Street 1:2355 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-3814
Practice Address - Country:US
Practice Address - Phone:734-794-0162
Practice Address - Fax:734-794-0168
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist