Healthcare Provider Details

I. General information

NPI: 1891779112
Provider Name (Legal Business Name): MRS. MELISSA D GOSLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 15TH AVE SW
SEATTLE WA
98106-2820
US

IV. Provider business mailing address

7310 47TH AVE SW #1
SEATTLE WA
98136-3017
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2728
  • Fax: 206-762-7630
Mailing address:
  • Phone: 206-225-5355
  • Fax: 206-762-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00039515
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: