Healthcare Provider Details

I. General information

NPI: 1679808646
Provider Name (Legal Business Name): CATHERINE LEDBETTER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
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

6145 90TH AVE SE
MERCER ISLAND WA
98040-4516
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax: 425-656-5447
Mailing address:
  • Phone: 206-232-9595
  • Fax: 206-275-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10593
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: