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General NPI Number Information
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NPI Number | 1942014048
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Entity Type | Individual
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Provider Name | BANCHEGIZE LUCY ANN SHELLEY
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Gender | Female
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 1609 MAIN ST STE B
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City | FREELAND
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State | WA
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Zip | 98249-9003
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Country | US
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Telephone | 360-331-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 3984 LAMBS REST LN
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City | GREENBANK
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State | WA
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Zip | 98253-9750
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Country | US
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Telephone | 360-914-8550
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 15692349
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License Number State | WA
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