Healthcare Provider Details

I. General information

NPI: 1831521269
Provider Name (Legal Business Name): MARY WILLIS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-3402
US

IV. Provider business mailing address

19605 NE 130TH CIR
BRUSH PRAIRIE WA
98606-3904
US

V. Phone/Fax

Practice location:
  • Phone: 360-260-3333
  • Fax:
Mailing address:
  • Phone: 360-901-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberFARR1027406
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberFARR1027406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: