Healthcare Provider Details

I. General information

NPI: 1124512918
Provider Name (Legal Business Name): MULUMEBET WUBISHET PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 20TH AVE
SEATTLE WA
98122-4734
US

IV. Provider business mailing address

7607 S SUNNYCREST RD
SEATTLE WA
98178-2747
US

V. Phone/Fax

Practice location:
  • Phone: 206-778-4034
  • Fax:
Mailing address:
  • Phone: 206-778-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH00015457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: