Healthcare Provider Details

I. General information

NPI: 1982688149
Provider Name (Legal Business Name): BARRY J ISARA CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NE UNIVERSITY VILLAGE ST
SEATTLE WA
98105-5016
US

IV. Provider business mailing address

17521 8TH AVE NE
SHORELINE WA
98155-3603
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-0705
  • Fax:
Mailing address:
  • Phone: 206-367-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00039179
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: