Healthcare Provider Details

I. General information

NPI: 1588933410
Provider Name (Legal Business Name): MARK W SHUMAKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 134TH PL SE
EVERETT WA
98208-9426
US

IV. Provider business mailing address

20401 15TH AVE W
LYNNWOOD WA
98036-7105
US

V. Phone/Fax

Practice location:
  • Phone: 425-332-6179
  • Fax:
Mailing address:
  • Phone: 425-332-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: