Individual
DIANE M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11913 NE 195TH ST, BOTHELL, WA 98011-3147
(425) 489-3100
(425) 489-3119
Mailing address
PO BOX 34584, SEATTLE, WA 98124-1584
(509) 241-7349
(509) 241-7628
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00010323
WA
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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