Provider Demographics
NPI:1063873362
Name:MCKEON, STEPHANIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 S FREYA ST STE 225
Mailing Address - Street 2:TURQUOISE FLAG BLDG
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4887
Mailing Address - Country:US
Mailing Address - Phone:509-536-1900
Mailing Address - Fax:509-343-5199
Practice Address - Street 1:104 S FREYA ST STE 225
Practice Address - Street 2:TURQUOISE FLAG BLDG
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4887
Practice Address - Country:US
Practice Address - Phone:509-536-1900
Practice Address - Fax:509-343-5199
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00019604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist