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General NPI Number Information
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NPI Number | 1699174672
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Entity Type | Individual
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Provider Name | JESSICA D TATE PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1115 13TH ST
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City | SNOHOMISH
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State | WA
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Zip | 98290-2012
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Country | US
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Telephone | 360-568-0548
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Fax |
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Provider Business Mailing Address
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Address Line | 325 RHODORA HEIGHTS RD
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City | LAKE STEVENS
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State | WA
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Zip | 98258-9276
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Country | US
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Telephone | 818-723-0615
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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 | PH60473390
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License Number State | WA
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