=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710262415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY A STARSKY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2011
-----------------------------------------------------
Last Update Date | 10/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 W STANLEY ST
-----------------------------------------------------
City | GRANITE FALLS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98252-8476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-691-4659
-----------------------------------------------------
Fax | 360-691-1487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23747 42ND AVE SE 37A
-----------------------------------------------------
City | BOTHELL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98021-7793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-419-5267
-----------------------------------------------------
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 | PH60178091
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------