Healthcare Provider Details

I. General information

NPI: 1346383510
Provider Name (Legal Business Name): COLLEEN JOHNSON WURDEN PH.D., R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 156TH AVE NE
REDMOND WA
98052-5513
US

IV. Provider business mailing address

6310 208TH AVE NE
REDMOND WA
98053-7808
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-5015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00056371
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035987L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: