Healthcare Provider Details

I. General information

NPI: 1104479765
Provider Name (Legal Business Name): RIETI CHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 8TH AVE S
SEATTLE WA
98104-3032
US

IV. Provider business mailing address

12451 NE 153RD PL
WOODINVILLE WA
98072-4676
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60214323
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: