Healthcare Provider Details

I. General information

NPI: 1548245053
Provider Name (Legal Business Name): SANDRA MIEKO OKAMURA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18420 AURORA AVE N
SHORELINE WA
98133-4416
US

IV. Provider business mailing address

12742 17TH AVE NE
SEATTLE WA
98125-4104
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-2948
  • Fax:
Mailing address:
  • Phone: 206-365-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00016311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: