Healthcare Provider Details

I. General information

NPI: 1801207972
Provider Name (Legal Business Name): SUSAN LAKEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 NE RADFORD DR #2012
SEATTLE WA
98115-7990
US

IV. Provider business mailing address

6180 NE RADFORD DR #2012
SEATTLE WA
98115-7990
US

V. Phone/Fax

Practice location:
  • Phone: 206-387-2638
  • Fax:
Mailing address:
  • Phone: 206-387-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00041910
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPH00041910
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPH00041910
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: