Healthcare Provider Details

I. General information

NPI: 1427694470
Provider Name (Legal Business Name): MAXWELL D DEMERITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 HOLMAN RD NW
SEATTLE WA
98117-2041
US

IV. Provider business mailing address

9999 HOLMAN RD NW
SEATTLE WA
98117-2041
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-4100
  • Fax:
Mailing address:
  • Phone: 206-782-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61500583
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: