MEDICARE: ICHIKO PETRIE PHARM.D.

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	PH 60471627	WA

General Provider Information

NPI Number	:	1477945822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ICHIKO PETRIE PHARM.D.

Provider Business Mailing Address
First Line	:	4515 148TH AVE NE
Second Line	:	APT JJ-202
City	:	BELLEVUE
State	:	WA
Zip	:	98007-3059
Country	:	US
Telephone Number	:	206-265-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 WESTERN AVE
Second Line	:	#100
City	:	SEATTLE
State	:	WA
Zip	:	98121-3017
Country	:	US
Telephone Number	:	800-523-3080
Fax Number	:

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

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	02/23/2015

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Directions to “ ICHIKO PETRIE PHARM.D.” Practice Location

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