Healthcare Provider Details

I. General information

NPI: 1598729030
Provider Name (Legal Business Name): MYRNA A ROMACK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE MAILSTOP 359798
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE MS 359798
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-731-8701
  • Fax: 206-731-3719
Mailing address:
  • Phone: 206-731-8701
  • Fax: 206-731-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00013786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: