Healthcare Provider Details

I. General information

NPI: 1114253143
Provider Name (Legal Business Name): JASON M RUSK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 75TH ST SW STE 220
EVERETT WA
98203-6293
US

IV. Provider business mailing address

1615 75TH ST SW STE 220
EVERETT WA
98203-6293
US

V. Phone/Fax

Practice location:
  • Phone: 425-247-3176
  • Fax:
Mailing address:
  • Phone: 425-247-3176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60098189
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: