Healthcare Provider Details

I. General information

NPI: 1962455949
Provider Name (Legal Business Name): STEPHANIE ANN MOJICA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN SUITE 210
KIRKLAND WA
98034-3099
US

IV. Provider business mailing address

22921 165TH AVE SE
MONROE WA
98272-8850
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-2790
  • Fax: 425-899-2795
Mailing address:
  • Phone: 360-794-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: