Healthcare Provider Details

I. General information

NPI: 1417211277
Provider Name (Legal Business Name): ROSEMARIE REGIS OCSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17633 HIGHWAY 99
LYNNWOOD WA
98037-3627
US

IV. Provider business mailing address

17633 HIGHWAY 99
LYNNWOOD WA
98037-3627
US

V. Phone/Fax

Practice location:
  • Phone: 425-743-7555
  • Fax: 425-745-0808
Mailing address:
  • Phone: 425-743-7555
  • Fax: 425-745-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00065424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: