Provider Demographics
NPI:1417368044
Name:MONROE, JON (RPH)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:MONROE
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 1:11901 FULTON ST E
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8613
Mailing Address - Country:US
Mailing Address - Phone:616-897-4710
Mailing Address - Fax:
Practice Address - Street 1:11901 FULTON ST E
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8613
Practice Address - Country:US
Practice Address - Phone:616-897-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020242601835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy