Healthcare Provider Details

I. General information

NPI: 1366949851
Provider Name (Legal Business Name): BLAIR BABER PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

400 S 43RD ST
RENTON WA
98055-5714
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax:
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60776158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: