Healthcare Provider Details

I. General information

NPI: 1255697918
Provider Name (Legal Business Name): RYAN KOENIGS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NE NORTHGATE WAY
SEATTLE WA
98125-6047
US

IV. Provider business mailing address

302 NE NORTHGATE WAY
SEATTLE WA
98125-6047
US

V. Phone/Fax

Practice location:
  • Phone: 206-494-0898
  • Fax: 206-494-0897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60276440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: