Healthcare Provider Details

I. General information

NPI: 1861757700
Provider Name (Legal Business Name): MISS NICOLETA RALUCA HURUBEANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11117 NE 109TH LN APT N203
KIRKLAND WA
98033-5093
US

IV. Provider business mailing address

11117 NE 109TH LN APT N203
KIRKLAND WA
98033-5093
US

V. Phone/Fax

Practice location:
  • Phone: 603-667-6583
  • Fax: 425-487-2004
Mailing address:
  • Phone: 603-667-6583
  • Fax: 425-487-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60192689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: