Healthcare Provider Details

I. General information

NPI: 1245014265
Provider Name (Legal Business Name): ADELINA LYNN GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W CLEARWATER AVE
KENNEWICK WA
99336-2945
US

IV. Provider business mailing address

2700 GRAYHAWK LOOP
RICHLAND WA
99354-4503
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-5412
  • Fax: 509-783-5479
Mailing address:
  • Phone: 509-554-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61453212
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: