Organization
OVERLAKE MEDICAL TOWER PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIE LEE PHD (PHCY MNGR)
(425) 688-5958
Entity
Organization
Contact information
Practice address
1135 116TH AVE NE, STE 105, BELLEVUE, WA 98004-4623
(425) 688-5958
(425) 467-3540
Mailing address
1135 116TH AVE NE, STE 105, BELLEVUE, WA 98004-4623
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00056713
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4928151
OTHER ID NUMBER
—
05
—
6023584
—
WA
Enumeration date
04/20/2007
Last updated
09/13/2007
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