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General NPI Number Information
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NPI Number | 1548249576
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Entity Type | Individual
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Provider Name | BENJAMIN MATTHEW MICHAELS
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 34515 9TH AVE S
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6761
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Country | US
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Telephone | 253-944-7966
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Fax | 253-944-7924
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Provider Business Mailing Address
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Address Line | 2518 S 364TH PL
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7102
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Country | US
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Telephone | 253-941-5291
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PH00020722
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License Number State | WA
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