Provider Demographics
NPI:1588646475
Name:GANONG, JAMES P (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:GANONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10002 AURORA AVE N
Mailing Address - Street 2:PMB 3305
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9347
Mailing Address - Country:US
Mailing Address - Phone:206-778-2832
Mailing Address - Fax:
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:206-431-5346
Practice Address - Fax:206-439-8559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist