Healthcare Provider Details

I. General information

NPI: 1144204041
Provider Name (Legal Business Name): LINDA MARIE HEAVNER PHARMARGY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12402 14TH AVE SW
BURIEN WA
98146-2617
US

IV. Provider business mailing address

12402 14TH AVE SW
BURIEN WA
98146-2617
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-6219
  • Fax:
Mailing address:
  • Phone: 206-244-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberVA00044252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: