MEDICARE: DR. CRAIG A PEDERSEN RPH, PHD

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	183500000X	Pharmacist	15057	WA

General Provider Information

NPI Number	:	1417953530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A PEDERSEN RPH, PHD

Provider Business Mailing Address
First Line	:	925 SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2742
Country	:	US
Telephone Number	:	206-588-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 SENECA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2742
Country	:	US
Telephone Number	:	62-588-9345
Fax Number	:

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	06/14/2024

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