MEDICARE: PAUL S VERBEURGT RPH

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	PH0042692	WA

General Provider Information

NPI Number	:	1962542068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL S VERBEURGT RPH

Provider Business Mailing Address
First Line	:	3101 WESTERN AVE
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98121-3017
Country	:	US
Telephone Number	:	206-826-1982
Fax Number	:	206-219-4000

Provider Business Practice Location Address
First Line	:	3101 WESTERN AVE
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98121-3017
Country	:	US
Telephone Number	:	206-826-1982
Fax Number	:	206-219-4000

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/31/2012

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