Healthcare Provider Details

I. General information

NPI: 1831163062
Provider Name (Legal Business Name): JESSICA L STERN PHA, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W MEEKER ST STE 4
KENT WA
98032-5766
US

IV. Provider business mailing address

PO BOX 50764
BELLEVUE WA
98015-0764
US

V. Phone/Fax

Practice location:
  • Phone: 253-850-9973
  • Fax:
Mailing address:
  • Phone: 253-850-9973
  • Fax: 253-850-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 00010679
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00020719
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: