Healthcare Provider Details

I. General information

NPI: 1063495513
Provider Name (Legal Business Name): HENRY DUANE STORTENBECKER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12946 SE KENT KANGLEY RD
KENT WA
98030-7940
US

IV. Provider business mailing address

1607 55TH CT SE
AUBURN WA
98092-8707
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-6874
  • Fax:
Mailing address:
  • Phone: 253-288-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP15380
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: