Provider Demographics
NPI:1023838703
Name:CATTRON, JONATHAN WARD
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WARD
Last Name:CATTRON
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 1:455 W 5TH S APT 12
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2395
Mailing Address - Country:US
Mailing Address - Phone:208-964-4594
Mailing Address - Fax:
Practice Address - Street 1:1855 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3043
Practice Address - Country:US
Practice Address - Phone:208-529-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5461970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist