MEDICARE: MR. MICHAEL CRIST

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	PH00039535	WA

General Provider Information

NPI Number	:	1821259532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CRIST

Provider Business Mailing Address
First Line	:	12345 LAKE CITY WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125
Country	:	US
Telephone Number	:	425-968-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	12345 LAKE CITY WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5401
Country	:	US
Telephone Number	:	425-968-8899
Fax Number	:

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	03/02/2012

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