=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639294218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTON H POON RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17220 REDMOND WAY
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98052-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-883-0607
-----------------------------------------------------
Fax | 425-883-4555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11625 SE 49TH ST
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98006-2713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-890-7701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH00039867
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------