Healthcare Provider Details

I. General information

NPI: 1922072537
Provider Name (Legal Business Name): EMILY VERLAINE LEAF PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

32412 53RD PL SW
FEDERAL WAY WA
98023-3602
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0242
  • Fax: 253-968-3349
Mailing address:
  • Phone: 253-874-7802
  • Fax: 253-968-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17414
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17414
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number00017414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: