Individual
LOC D NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6300 E LAKE SAMMAMISH PKWY SE, ISSAQUAH, WA 98029-8935
(425) 369-0265
Mailing address
6300 E LAKE SAMMAMISH PKWY SE, ISSAQUAH, WA 98029-8935
(425) 369-0265
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60572730
WA
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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