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General NPI Number Information
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NPI Number | 1427693258
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Entity Type | Individual
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Provider Name | MAX DWIGHT PHELPS PH00009411
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Gender | Male
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 25316 74TH AVE S STE 105
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City | KENT
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State | WA
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Zip | 98032-6022
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Country | US
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Telephone | 800-562-8386
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Fax | 800-421-7772
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Provider Business Mailing Address
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Address Line | 23234 114TH WAY SE
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City | KENT
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State | WA
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Zip | 98031-3429
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Country | US
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Telephone | 206-683-1035
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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 | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | PH00009411
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License Number State | WA
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