Healthcare Provider Details

I. General information

NPI: 1174661805
Provider Name (Legal Business Name): MICHEAL HENRY PD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

IV. Provider business mailing address

6503 52ND AVE NE
SEATTLE WA
98115-7744
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-6196
  • Fax:
Mailing address:
  • Phone: 206-522-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPH00020389
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: