Healthcare Provider Details

I. General information

NPI: 1497185854
Provider Name (Legal Business Name): SHARON WYLLYS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 E NOB HILL BLVD
YAKIMA WA
98901-9502
US

IV. Provider business mailing address

2304 E NOB HILL BLVD
YAKIMA WA
98901-9502
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-7552
  • Fax:
Mailing address:
  • Phone: 509-575-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: