Healthcare Provider Details

I. General information

NPI: 1730441494
Provider Name (Legal Business Name): PEGGY E VANBUSKIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NE STATE ROUTE 300
BELFAIR WA
98528-9617
US

IV. Provider business mailing address

NE 201 STATE RT 300
BELFAIR WA
98528-0000
US

V. Phone/Fax

Practice location:
  • Phone: 360-275-9671
  • Fax: 360-275-9581
Mailing address:
  • Phone: 360-275-9671
  • Fax: 360-275-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: