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General NPI Number Information
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NPI Number | 1609058635
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Entity Type | Individual
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Provider Name | JAKE R RICHARDS CPHT
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Gender | Male
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 23211 HWY 99 APT A308
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City | EDMONDS
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State | WA
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Zip | 98026-8777
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Country | US
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Telephone | 425-314-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 23211 HWY 99 APT A308
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City | EDMONDS
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State | WA
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Zip | 98026-8777
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Country | US
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Telephone | 425-314-8881
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | VA00066500
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License Number State | WA
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