MEDICARE: MRS. WENDY KAY BREMER 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		WA

General Provider Information

NPI Number	:	1487638383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY KAY BREMER RPH

Provider Business Mailing Address
First Line	:	2225 122ND DR SE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98205-4511
Country	:	US
Telephone Number	:	425-335-5501
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 SR 9
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-8525
Country	:	US
Telephone Number	:	425-334-4028
Fax Number	:

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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