Individual
DIANNE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
6426 NE 182ND ST, KENMORE, WA 98028-4813
(206) 650-0077
Mailing address
PO BOX 82688, KENMORE, WA 98028-0688
(206) 650-0077
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00021609
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH00021609
PHARMACIST LICENSE
WA
Enumeration date
02/06/2014
Last updated
02/06/2014
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