Healthcare Provider Details

I. General information

NPI: 1225012107
Provider Name (Legal Business Name): SCOTT ALAN MIHULKA PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E NORTH BEND WAY
NORTH BEND WA
98045-8270
US

IV. Provider business mailing address

460 E NORTH BEND WAY
NORTH BEND WA
98045-8270
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-2357
  • Fax: 425-831-1953
Mailing address:
  • Phone: 425-888-2357
  • Fax: 425-831-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00039643
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: