Healthcare Provider Details

I. General information

NPI: 1598742991
Provider Name (Legal Business Name): REBECCA DARLENE WILKE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 NE 4TH ST
RENTON WA
98059-4800
US

IV. Provider business mailing address

16625 113TH AVE SE
RENTON WA
98055-5258
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-1015
  • Fax: 425-235-9703
Mailing address:
  • Phone: 425-226-1405
  • Fax: 425-204-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00061424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: