Organization
EVERGREENHEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE A CERMAK RPH (PHARMACIST)
(425) 899-2783
Entity
Organization
Contact information
Practice address
12333 NE 130TH LN, TAN 415, KIRKLAND, WA 98034-7467
(425) 899-2783
(425) 899-2784
Mailing address
12333 NE 130TH LN, TAN 415, KIRKLAND, WA 98034-7467
(425) 899-2783
(425) 899-2784
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
PH0009804
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH00009804
PHARMACY LICENSE
WA
Enumeration date
02/02/2015
Last updated
02/02/2015
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