Healthcare Provider Details

I. General information

NPI: 1891906897
Provider Name (Legal Business Name): BRAD LINDSAY WHEELOCK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 DENVER AVE S
SEATTLE WA
98134-2316
US

IV. Provider business mailing address

2126 N ANDERSON ST
TACOMA WA
98406-7122
US

V. Phone/Fax

Practice location:
  • Phone: 206-767-1373
  • Fax: 206-767-1397
Mailing address:
  • Phone: 253-759-4097
  • Fax: 206-767-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH21078
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: