Provider Demographics
NPI:1962252189
Name:ALONZO, JESSE LEWIS (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LEWIS
Last Name:ALONZO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 4TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2961
Mailing Address - Country:US
Mailing Address - Phone:253-777-5971
Mailing Address - Fax:
Practice Address - Street 1:1250 N HIGHWAY
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2005
Practice Address - Country:US
Practice Address - Phone:509-684-3151
Practice Address - Fax:509-684-3233
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60877265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist