Healthcare Provider Details

I. General information

NPI: 1003890245
Provider Name (Legal Business Name): LAUREEN B. LILJEGREN R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 228TH AVE NE
SAMMAMISH WA
98074-7226
US

IV. Provider business mailing address

18407 NE 133RD ST
WOODINVILLE WA
98072-6340
US

V. Phone/Fax

Practice location:
  • Phone: 425-868-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00010290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: