Healthcare Provider Details

I. General information

NPI: 1316923451
Provider Name (Legal Business Name): PATRICIA J LYTLE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

PO BOX 327
RAVENSDALE WA
98051-0327
US

V. Phone/Fax

Practice location:
  • Phone: 253-372-7220
  • Fax: 253-372-7221
Mailing address:
  • Phone: 360-886-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00017944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: