Healthcare Provider Details

I. General information

NPI: 1548261464
Provider Name (Legal Business Name): KRISTIE JO MARLETT PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19116 33RD AVE W
LYNNWOOD WA
98036-4706
US

IV. Provider business mailing address

8609 76TH AVE NE
MARYSVILLE WA
98270-7885
US

V. Phone/Fax

Practice location:
  • Phone: 425-712-7900
  • Fax: 425-712-7995
Mailing address:
  • Phone: 360-658-5951
  • Fax: 425-712-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00017553
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00017553
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00017553
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH00017553
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00017553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: