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General NPI Number Information
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NPI Number | 1922355072
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Entity Type | Individual
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Provider Name | BRIGHAM R CONSOLIVER RPH
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Gender | Male
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 424 E 2ND ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-3119
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Country | US
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Telephone | 360-452-4200
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Fax | 360-457-6557
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Provider Business Mailing Address
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Address Line | 123 MARY JO LN
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City | SEQUIM
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State | WA
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Zip | 98382-6973
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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 | PPH00017274
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License Number State | WA
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