Healthcare Provider Details

I. General information

NPI: 1598957359
Provider Name (Legal Business Name): JOHN MICHAEL SONTRA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

907 HOYT AVE
EVERETT WA
98201-1323
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-3620
  • Fax:
Mailing address:
  • Phone: 425-252-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH10791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: