Healthcare Provider Details

I. General information

NPI: 1851370183
Provider Name (Legal Business Name): JESSICA LE MASSEY PHCY-TEC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7683 SE 27TH ST
MERCER ISLAND WA
98040-2804
US

IV. Provider business mailing address

7683 SE 27TH ST
MERCER ISLAND WA
98040-2804
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-3194
  • Fax:
Mailing address:
  • Phone: 425-454-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00051796
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: