Provider Demographics
NPI:1306100714
Name:BEMIS, SHANNON MICHELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MICHELLE
Last Name:BEMIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 164TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6305
Mailing Address - Country:US
Mailing Address - Phone:425-743-4806
Mailing Address - Fax:425-742-9305
Practice Address - Street 1:926 164TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6305
Practice Address - Country:US
Practice Address - Phone:425-743-4806
Practice Address - Fax:425-742-9305
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60266875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist