Healthcare Provider Details

I. General information

NPI: 1265787907
Provider Name (Legal Business Name): SSU-WEI CHYAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NE NORTHGATE WAY
SEATTLE WA
98125
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: 206-494-9902
Mailing address:
  • Phone: 206-494-0898
  • Fax: 206-494-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60118718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: