Healthcare Provider Details

I. General information

NPI: 1801865126
Provider Name (Legal Business Name): JENNIFER CAREY MEHLBERG PHARM.D., CACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE PHARMACY, BOX 354735
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

3419 21ST AVE W
SEATTLE WA
98199-2304
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-5579
  • Fax: 206-598-2717
Mailing address:
  • Phone: 206-598-7566
  • Fax: 206-598-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00019459
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00019459
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: