=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336633767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN JEMISON PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2018
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 MADISON ST STE 444
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-3588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-386-6215
-----------------------------------------------------
Fax | 206-386-2134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1221 MADISON ST STE 444
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-3588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-386-6215
-----------------------------------------------------
Fax | 206-386-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH60161289
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------