Healthcare Provider Details

I. General information

NPI: 1831447705
Provider Name (Legal Business Name): QFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2012
Last Update Date: 08/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8867 161ST AVE NE
REDMOND WA
98052-3585
US

IV. Provider business mailing address

8867 161ST AVE NE
REDMOND WA
98052-3585
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-7474
  • Fax: 425-869-0580
Mailing address:
  • Phone: 425-869-7474
  • Fax: 425-869-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00010787
License Number StateWA

VIII. Authorized Official

Name: SUSAN ELISE GUNN
Title or Position: PHARMACIST
Credential: RPH
Phone: 425-869-7474