Healthcare Provider Details

I. General information

NPI: 1295406569
Provider Name (Legal Business Name): JIMMY FRANDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2021
Last Update Date: 09/25/2021
Certification Date: 09/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 W WELLESLEY AVE STE A
SPOKANE WA
99205-5091
US

IV. Provider business mailing address

5611 SWENSON RD
NINE MILE FALLS WA
99026-9522
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-7887
  • Fax:
Mailing address:
  • Phone: 805-754-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61114906
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: