Healthcare Provider Details

I. General information

NPI: 1043293707
Provider Name (Legal Business Name): MRS. MARCIE MARIE SREY
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 DENVER AVE S
SEATTLE WA
98134-2316
US

IV. Provider business mailing address

846 SW 308TH ST
FEDERAL WAY WA
98023-8236
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2626
  • Fax:
Mailing address:
  • Phone: 253-528-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00052413
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: