Healthcare Provider Details

I. General information

NPI: 1467696427
Provider Name (Legal Business Name): MICHELE M VERCELLA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 EASTLAKE AVE E SUITE 400
SEATTLE WA
98102-3345
US

IV. Provider business mailing address

2324 EASTLAKE AVE E SUITE 400
SEATTLE WA
98102-3345
US

V. Phone/Fax

Practice location:
  • Phone: 206-427-6311
  • Fax: 206-838-4599
Mailing address:
  • Phone: 206-427-6311
  • Fax: 206-838-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number00016564
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: