Healthcare Provider Details

I. General information

NPI: 1528292489
Provider Name (Legal Business Name): EVA SANJINES PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3066 ISSAQUAH PINE LAKE RD SE RITE AID 5188
SAMMAMISH WA
98075-7253
US

IV. Provider business mailing address

3066 ISSAQUAH PINE LAKE RD SE RITE AID 5188
SAMMAMISH WA
98075-7253
US

V. Phone/Fax

Practice location:
  • Phone: 425-391-1582
  • Fax: 425-391-8361
Mailing address:
  • Phone: 425-391-1582
  • Fax: 425-391-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00039175
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH49391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: