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General NPI Number Information
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NPI Number | 1912956848
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Entity Type | Individual
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Provider Name | ELIZABETH ANN BAKKEN PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 S GRAND AVE
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City | PULLMAN
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State | WA
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Zip | 99163-4900
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Country | US
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Telephone | 509-332-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 845 SE HIGH ST
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City | PULLMAN
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State | WA
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Zip | 99163-2265
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Country | US
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Telephone | 509-332-5380
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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 | PH00013586
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P5716
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License Number State | ID
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