Healthcare Provider Details

I. General information

NPI: 1659351294
Provider Name (Legal Business Name): LISA DEPRIEST PHARMACY TEHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14277 PACIFIC HWY S
TUKWILA WA
98168-4124
US

IV. Provider business mailing address

17429 158TH AVE SE
RENTON WA
98058-9156
US

V. Phone/Fax

Practice location:
  • Phone: 206-431-9652
  • Fax: 206-431-0470
Mailing address:
  • Phone: 425-254-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00019263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: