Healthcare Provider Details

I. General information

NPI: 1104148683
Provider Name (Legal Business Name): JESSICA RITCHIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 46TH DR SE
EVERETT WA
98208-9662
US

IV. Provider business mailing address

17788 147TH ST SE
MONROE WA
98272-1030
US

V. Phone/Fax

Practice location:
  • Phone: 206-778-1321
  • Fax:
Mailing address:
  • Phone: 360-794-7351
  • Fax: 360-794-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60097680
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: