Healthcare Provider Details

I. General information

NPI: 1992246300
Provider Name (Legal Business Name): MARGERY ROXANE DELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 N MONTESANO ST
WESTPORT WA
98595-0385
US

IV. Provider business mailing address

PO BOX 453
WESTPORT WA
98595-0453
US

V. Phone/Fax

Practice location:
  • Phone: 360-268-0505
  • Fax: 360-268-1302
Mailing address:
  • Phone: 360-268-0505
  • Fax: 360-268-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60713321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: