MEDICARE: MRS. MELISSA D GOSLIN

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	VA00039515	WA

General Provider Information

NPI Number	:	1891779112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA D GOSLIN

Provider Business Mailing Address
First Line	:	7310 47TH AVE SW
Second Line	:	#1
City	:	SEATTLE
State	:	WA
Zip	:	98136-3017
Country	:	US
Telephone Number	:	206-225-5355
Fax Number	:	206-762-7630

Provider Business Practice Location Address
First Line	:	9600 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2820
Country	:	US
Telephone Number	:	206-763-2728
Fax Number	:	206-762-7630

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	12/16/2008

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