Healthcare Provider Details

I. General information

NPI: 1790823433
Provider Name (Legal Business Name): LISA A. O'BROCHTA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2700 152ND AVE NE
REDMOND WA
98052-5543
US

IV. Provider business mailing address

11550 172ND AVE NE
REDMOND WA
98052-7231
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-5988
  • Fax:
Mailing address:
  • Phone: 425-881-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: