Provider Demographics
NPI:1740574821
Name:BOX, JONATHAN C (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:BOX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9351
Mailing Address - Country:US
Mailing Address - Phone:702-219-2270
Mailing Address - Fax:
Practice Address - Street 1:4001 S MARYLAND PKWY
Practice Address - Street 2:T0265
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7556
Practice Address - Country:US
Practice Address - Phone:702-732-1840
Practice Address - Fax:702-732-1840
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist