MEDICARE: RUTH B IREDALE 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	PH00022371	WA

General Provider Information

NPI Number	:	1366892275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH B IREDALE RPH

Provider Business Mailing Address
First Line	:	990 E WASHINGTON ST
Second Line	:	SUITE B
City	:	SEQUIM
State	:	WA
Zip	:	98382-3517
Country	:	US
Telephone Number	:	360-683-1156
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 E WASHINGTON ST
Second Line	:	SUITE B
City	:	SEQUIM
State	:	WA
Zip	:	98382-3517
Country	:	US
Telephone Number	:	360-683-1156
Fax Number	:	360-683-8532

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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