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General NPI Number Information
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NPI Number | 1902847296
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Entity Type | Individual
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Provider Name | STEPHEN LAWRENCE BOULANGER RPH.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 22316 70TH AVE W STE 5
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2184
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Country | US
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Telephone | 425-673-5200
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Fax | 425-673-5230
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Provider Business Mailing Address
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Address Line | 20232 21ST AVE NW
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City | SHORELINE
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State | WA
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Zip | 98177-2314
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Country | US
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Telephone |
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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 | PH00013587
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License Number State | WA
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