Healthcare Provider Details

I. General information

NPI: 1548243397
Provider Name (Legal Business Name): PATRICIA ANN BENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 102ND ST NE
MARYSVILLE WA
98270-6600
US

IV. Provider business mailing address

6005 102ND ST NE
MARYSVILLE WA
98270-6600
US

V. Phone/Fax

Practice location:
  • Phone: 360-651-1234
  • Fax:
Mailing address:
  • Phone: 360-651-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00012096
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: