MEDICARE: MRS. DANA RAPHAELY

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	1835P1200X	Pharmacotherapy Pharmacist	00016676	WA

General Provider Information

NPI Number	:	1417081514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA RAPHAELY

Provider Business Mailing Address
First Line	:	7611 85TH PL SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-5728
Country	:	US
Telephone Number	:	206-236-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 ROOSEVELT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-3042
Country	:	US
Telephone Number	:	206-729-7514
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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