Healthcare Provider Details

I. General information

NPI: 1548806169
Provider Name (Legal Business Name): MARIANNE BACH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25316 74TH AVE S STE 105
KENT WA
98032-6022
US

IV. Provider business mailing address

5310 NE 3RD ST
RENTON WA
98059-5188
US

V. Phone/Fax

Practice location:
  • Phone: 800-562-8386
  • Fax: 800-421-7772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00051456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: