Healthcare Provider Details

I. General information

NPI: 1720525249
Provider Name (Legal Business Name): JANELLE BLAKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2017
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 GRIFFIN AVE 102
ENUMCLAW WA
98022-2409
US

IV. Provider business mailing address

9318 229TH AVE E
BUCKLEY WA
98321-7441
US

V. Phone/Fax

Practice location:
  • Phone: 800-998-2611
  • Fax:
Mailing address:
  • Phone: 253-753-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00015957
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: