Healthcare Provider Details

I. General information

NPI: 1922459890
Provider Name (Legal Business Name): JORDAN DUFRENE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18921 BOTHELL WAY NE
BOTHELL WA
98011-1934
US

IV. Provider business mailing address

18921 BOTHELL WAY NE
BOTHELL WA
98011-1934
US

V. Phone/Fax

Practice location:
  • Phone: 425-487-3031
  • Fax: 425-487-2004
Mailing address:
  • Phone: 425-487-3031
  • Fax: 425-487-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60632450
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60632450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: