Healthcare Provider Details

I. General information

NPI: 1982987285
Provider Name (Legal Business Name): HALEY ANN CAMUSO PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
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

4727 DENVER AVE S
SEATTLE WA
98134-2316
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2626
  • Fax: 206-767-1397
Mailing address:
  • Phone: 206-763-2626
  • Fax: 206-767-1397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00070981
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number410101070950299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: