Healthcare Provider Details

I. General information

NPI: 1184378366
Provider Name (Legal Business Name): YEKATERINA MOVCHAN CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18906 US 2
MONROE WA
98272-1415
US

IV. Provider business mailing address

7701 HARDESON RD UNIT 123
EVERETT WA
98203-6267
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-0943
  • Fax:
Mailing address:
  • Phone: 425-319-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61096769
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: