Healthcare Provider Details

I. General information

NPI: 1003893777
Provider Name (Legal Business Name): WILLIAM D EATON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 5TH AVE
SEATTLE WA
98101-1606
US

IV. Provider business mailing address

13529 25TH AVE NE
SEATTLE WA
98125-3407
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-0582
  • Fax: 206-343-2328
Mailing address:
  • Phone: 206-362-6651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10629
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: