Healthcare Provider Details

I. General information

NPI: 1124129630
Provider Name (Legal Business Name): ULANA STEPHANIE PEDERSEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

2526 28TH AVE W
SEATTLE WA
98199-3366
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2174
  • Fax:
Mailing address:
  • Phone: 206-282-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032995
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number032995
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00071492
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: