Healthcare Provider Details

I. General information

NPI: 1083970933
Provider Name (Legal Business Name): SHAWNETT STENBERG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17788 147TH ST SE
MONROE WA
98272-1030
US

IV. Provider business mailing address

20113 65TH AVE SE
SNOHOMISH WA
98296-5381
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7351
  • Fax:
Mailing address:
  • Phone: 360-668-9882
  • Fax: 360-668-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00014820
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: