Provider Demographics
NPI:1457765364
Name:JONES, MICHAEL SHANNON (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHANNON
Last Name:JONES
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 1:15407 MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7375
Mailing Address - Country:US
Mailing Address - Phone:425-385-2400
Mailing Address - Fax:425-385-3969
Practice Address - Street 1:15407 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7375
Practice Address - Country:US
Practice Address - Phone:425-385-2400
Practice Address - Fax:425-385-3969
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00010993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist