MEDICARE: MRS. MARCIA LEIGH DEFFENBAUGH RPH

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
1	183500000X	Pharmacist	PH00014588	WA

General Provider Information

NPI Number	:	1134371602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA LEIGH DEFFENBAUGH RPH

Provider Business Mailing Address
First Line	:	101 N ELY ST
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-2941
Country	:	US
Telephone Number	:	509-783-1438
Fax Number	:	509-783-3321

Provider Business Practice Location Address
First Line	:	101 N ELY ST
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-2941
Country	:	US
Telephone Number	:	509-783-1438
Fax Number	:	509-783-3321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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