Healthcare Provider Details

I. General information

NPI: 1538126859
Provider Name (Legal Business Name): JENNIFER ROSE BEACH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 ROOSEVELT WAY NE SUITE 101
SEATTLE WA
98105-6099
US

IV. Provider business mailing address

8044 14TH AVE NE
SEATTLE WA
98115-4329
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-4985
  • Fax: 206-598-4976
Mailing address:
  • Phone: 206-985-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00039934
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: