MEDICARE: REGINA R CORDOVA PHARMACY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	60231176	WA

General Provider Information

NPI Number	:	1316206782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA R CORDOVA PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	1929 QUEEN ANNE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2549
Country	:	US
Telephone Number	:	206-285-1737
Fax Number	:	206-285-1791

Provider Business Practice Location Address
First Line	:	1929 QUEEN ANNE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2549
Country	:	US
Telephone Number	:	206-285-1737
Fax Number	:	206-285-1791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/04/2012

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