Healthcare Provider Details

I. General information

NPI: 1912812504
Provider Name (Legal Business Name): JAKE BRENTON BIRNEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32129 WEYERHAEUSER WAY S STE 100
FEDERAL WAY WA
98001-9801
US

IV. Provider business mailing address

32129 WEYERHAEUSER WAY S STE 100
FEDERAL WAY WA
98001-9801
US

V. Phone/Fax

Practice location:
  • Phone: 360-933-4892
  • Fax:
Mailing address:
  • Phone: 360-933-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.61454878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: