Healthcare Provider Details

I. General information

NPI: 1932535549
Provider Name (Legal Business Name): JI SON MUN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 ROOSEVELT WAY NE
SEATTLE WA
98125-6234
US

IV. Provider business mailing address

11100 ROOSEVELT WAY NE
SEATTLE WA
98125-6234
US

V. Phone/Fax

Practice location:
  • Phone: 206-361-0188
  • Fax:
Mailing address:
  • Phone: 206-361-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60381828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: