Healthcare Provider Details

I. General information

NPI: 1619215688
Provider Name (Legal Business Name): BRIAN DIAZ RPH, PHARMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 15TH AVE
SEATTLE WA
98122-5601
US

IV. Provider business mailing address

109 15TH AVE
SEATTLE WA
98122-5601
US

V. Phone/Fax

Practice location:
  • Phone: 206-890-0150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60267031
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: