MEDICARE: MRS. STEPHANIE MCKEON R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH 00019604	WA

General Provider Information

NPI Number	:	1063873362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE MCKEON R.PH.

Provider Business Mailing Address
First Line	:	104 S FREYA ST STE 225
Second Line	:	TURQUOISE FLAG BLDG
City	:	SPOKANE
State	:	WA
Zip	:	99202-4887
Country	:	US
Telephone Number	:	509-536-1900
Fax Number	:	509-343-5199

Provider Business Practice Location Address
First Line	:	104 S FREYA ST STE 225
Second Line	:	TURQUOISE FLAG BLDG
City	:	SPOKANE
State	:	WA
Zip	:	99202-4887
Country	:	US
Telephone Number	:	509-536-1900
Fax Number	:	509-343-5199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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