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Individual

MR. SHAIN JESSUP DAMMON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARM D

Contact information

Practice address
1203 IDAHO ST, LEWISTON, ID 83501-1940
(208) 848-8290
(208) 848-8291
Mailing address
611 N IRON BRIDGE WAY, SPOKANE, WA 99202-4932
(208) 848-8290
(208) 848-8291

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5849
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6968
NONE
ID
01
6968696869
NONE
HI
Enumeration date
09/29/2009
Last updated
05/06/2020
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