Healthcare Provider Details

I. General information

NPI: 1043787922
Provider Name (Legal Business Name): JANE NAZARENO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 DELRIDGE WAY SW STE 400
SEATTLE WA
98106-1273
US

IV. Provider business mailing address

1959 NE PACIFIC ST # H362
SEATTLE WA
98195-0001
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61200534
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: