Healthcare Provider Details

I. General information

NPI: 1760752299
Provider Name (Legal Business Name): MRS. MICHELE SKOMORUCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 E SUNSET DR
BELLINGHAM WA
98226-3509
US

IV. Provider business mailing address

3632 KANSAS ST
BELLINGHAM WA
98229-6060
US

V. Phone/Fax

Practice location:
  • Phone: 360-647-2713
  • Fax:
Mailing address:
  • Phone: 206-427-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40934
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002918
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: