Healthcare Provider Details

I. General information

NPI: 1811923238
Provider Name (Legal Business Name): PAM DENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17788 147TH ST SE
MONROE WA
98272-1030
US

IV. Provider business mailing address

12023 100TH AVE NE
KIRKLAND WA
98034-3811
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7351
  • Fax:
Mailing address:
  • Phone: 425-231-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00057024
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: