Healthcare Provider Details

I. General information

NPI: 1013987676
Provider Name (Legal Business Name): MS. KARYN LUCILLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22803 44TH AVE W
MOUNTLAKE TERRACE WA
98043-5032
US

IV. Provider business mailing address

21204 38TH PL W
BRIER WA
98036-6810
US

V. Phone/Fax

Practice location:
  • Phone: 425-771-3738
  • Fax:
Mailing address:
  • Phone: 425-640-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00015033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: