Healthcare Provider Details

I. General information

NPI: 1982772380
Provider Name (Legal Business Name): DAWN MARIE IPSEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 AVENUE D
SNOHOMISH WA
98290-2333
US

IV. Provider business mailing address

10827 201ST ST SE
SNOHOMISH WA
98296-8198
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-7787
  • Fax: 360-568-3626
Mailing address:
  • Phone: 360-668-0455
  • Fax: 360-568-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH39847
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: