MEDICARE: MRS. THERESA KAE ARNESON 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	174400000X	Specialist	PH 00022073	WA
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PH 00022073	WA

General Provider Information

NPI Number	:	1376984286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA KAE ARNESON RPH

Provider Business Mailing Address
First Line	:	9722 HUNTER POINT RD NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9708
Country	:	US
Telephone Number	:	360-866-0698
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 MCPHEE RD SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5080
Country	:	US
Telephone Number	:	360-956-2543
Fax Number	:	360-956-2545

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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