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General NPI Number Information
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NPI Number | 1386263820
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Entity Type | Individual
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Provider Name | DENEICE GURRAD RPH
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 90 SE KLAH CHE MIN DR
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City | SHELTON
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State | WA
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Zip | 98584-9216
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Country | US
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Telephone | 360-432-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 5439 KLIPSUN LN SW
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City | OLYMPIA
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State | WA
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Zip | 98512-7937
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Country | US
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Telephone | 360-790-1891
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH00019299
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License Number State | WA
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