Healthcare Provider Details

I. General information

NPI: 1861815458
Provider Name (Legal Business Name): CARLA HIBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 02/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 N LIDGERWOOD ST
SPOKANE WA
99208-1124
US

IV. Provider business mailing address

6002 N LIDGERWOOD ST
SPOKANE WA
99208-1124
US

V. Phone/Fax

Practice location:
  • Phone: 509-850-6910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00048299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: