Healthcare Provider Details

I. General information

NPI: 1144509308
Provider Name (Legal Business Name): ELINA BASKINA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14692 179TH AVE SE STE 200
MONROE WA
98272-1160
US

IV. Provider business mailing address

14692 179TH AVE SE STE 200
MONROE WA
98272-1160
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-5555
  • Fax: 360-794-0749
Mailing address:
  • Phone: 360-794-5555
  • Fax: 360-794-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60231062
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: