Healthcare Provider Details

I. General information

NPI: 1912246042
Provider Name (Legal Business Name): ELYSE DIANA DAVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2013
Last Update Date: 02/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 16TH AVE E
SEATTLE WA
98112-5226
US

IV. Provider business mailing address

13625 SE 10TH ST
BELLEVUE WA
98005-3715
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-2880
  • Fax:
Mailing address:
  • Phone: 425-941-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60233022
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: