MEDICARE: FAITH MCDEVITT LIIKALA R.PH.

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	PH00013714	WA

General Provider Information

NPI Number	:	1497736417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH MCDEVITT LIIKALA R.PH.

Provider Business Mailing Address
First Line	:	175 SE ANDREWS ST
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-3419
Country	:	US
Telephone Number	:	425-392-8650
Fax Number	:	425-391-8624

Provider Business Practice Location Address
First Line	:	450 NW GILMAN BLVD
Second Line	:	SUITE 107
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2483
Country	:	US
Telephone Number	:	425-392-8650
Fax Number	:	425-391-8624

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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