Healthcare Provider Details

I. General information

NPI: 1366872798
Provider Name (Legal Business Name): IPSEN PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 AVENUE D SUITE 102
SNOHOMISH WA
98290-2387
US

IV. Provider business mailing address

700 AVENUE D STE 102
SNOHOMISH WA
98290-2387
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number60434626
License Number StateWA

VIII. Authorized Official

Name: DAWN IPSEN
Title or Position: OWNER
Credential:
Phone: 360-568-1297