Healthcare Provider Details

I. General information

NPI: 1659690634
Provider Name (Legal Business Name): SCOTT BRANTING STROM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2010
Last Update Date: 05/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18906 STATE ROUTE 2
MONROE WA
98272-1415
US

IV. Provider business mailing address

18906 STATE ROUTE 2
MONROE WA
98272-1415
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-0943
  • Fax: 360-794-4924
Mailing address:
  • Phone: 360-794-0943
  • Fax: 360-794-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00013791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: