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NPI Code Detail

MEDICARE: JEREMY ROTH

MEDICARE: JEREMY ROTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy TechnicianVA00057033WA

General Provider Information

NPI Number : 1013943927
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY ROTH
Provider Business Mailing Address
First Line : 2232 NE 197TH PL
Second Line :
City : SHORELINE
State : WA
Zip : 98155-1235
Country : US
Telephone Number : 206-384-7376
Fax Number :
Provider Business Practice Location Address
First Line : 2222 32ND AVE W
Second Line :
City : SEATTLE
State : WA
Zip : 98199-4044
Country : US
Telephone Number : 206-282-2881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 07/08/2007

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Directions to “ JEREMY ROTH ” Practice Location

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