Healthcare Provider Details

I. General information

NPI: 1871070441
Provider Name (Legal Business Name): ELVIRA T SAGUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 42ND AVE SW
SEATLLE WA
98116-2513
US

IV. Provider business mailing address

2345 42ND AVE SW
SEATTLE WA
98116-2513
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-7437
  • Fax:
Mailing address:
  • Phone: 206-932-7437
  • Fax: 206-932-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: