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General NPI Number Information
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NPI Number | 1174211015
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Entity Type | Individual
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Provider Name | JUSTIN RODERICK PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 21202 24TH AVE S
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City | DES MOINES
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State | WA
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Zip | 98198-4328
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Country | US
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Telephone | 206-767-1347
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Fax |
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Provider Business Mailing Address
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Address Line | 225 CEDAR ST
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City | SEATTLE
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State | WA
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Zip | 98121-5200
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Country | US
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Telephone | 207-270-1099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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