Healthcare Provider Details

I. General information

NPI: 1194028753
Provider Name (Legal Business Name): GEORGE ALPHONSE DOTY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24008 SNO WOOD RD
WOODINVILLE WA
98072-9743
US

IV. Provider business mailing address

24008 SNO WOOD RD
WOODINVILLE WA
98072-9743
US

V. Phone/Fax

Practice location:
  • Phone: 425-806-7728
  • Fax: 425-806-7725
Mailing address:
  • Phone: 425-806-7728
  • Fax: 425-806-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00009528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: