Provider Demographics
NPI:1326370131
Name:MYKLEGARD, JASON C (RPH)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:MYKLEGARD
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 1:8224 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6157
Mailing Address - Country:US
Mailing Address - Phone:253-581-0494
Mailing Address - Fax:253-581-0997
Practice Address - Street 1:8224 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6157
Practice Address - Country:US
Practice Address - Phone:253-581-0494
Practice Address - Fax:253-581-0997
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist