Healthcare Provider Details

I. General information

NPI: 1497739460
Provider Name (Legal Business Name): MRS. ELIZABETH MARGARET RITTENHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 A ST SE
AUBURN WA
98002-8610
US

IV. Provider business mailing address

12610 135TH ST E
PUYALLUP WA
98374-4668
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-8563
  • Fax: 253-939-0869
Mailing address:
  • Phone: 253-435-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00040361
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: