=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326586579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH FAULKNER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2017
-----------------------------------------------------
Last Update Date | 02/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17000 140TH AVE NE UNIT E101
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-6903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-485-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17000 140TH AVE NE UNIT E101
-----------------------------------------------------
City | WOODINVILLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98072-6903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-485-2900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | PH60004917
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------