Provider Demographics
NPI:1730489246
Name:MONSON, JOHN EDWARD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MONSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 PINE ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2600
Mailing Address - Country:US
Mailing Address - Phone:530-247-3040
Mailing Address - Fax:530-247-3044
Practice Address - Street 1:2275 PINE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2600
Practice Address - Country:US
Practice Address - Phone:530-247-3040
Practice Address - Fax:530-247-3044
Is Sole Proprietor?:No
Enumeration Date:2010-10-31
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist