Healthcare Provider Details

I. General information

NPI: 1104806033
Provider Name (Legal Business Name): LAURA JO WRAY PHARMACY TECNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 42ND AVE SW
SEATTLE WA
98116-2513
US

IV. Provider business mailing address

9336 31ST PL SW
SEATTLE WA
98126-3939
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-7437
  • Fax:
Mailing address:
  • Phone: 206-938-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00041816
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: