MEDICARE: JESSICA LE MASSEY PHCY-TEC

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	183700000X	Pharmacy Technician	VA00051796	WA

General Provider Information

NPI Number	:	1851370183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LE MASSEY PHCY-TEC

Provider Business Mailing Address
First Line	:	7683 SE 27TH ST
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	425-454-3194
Fax Number	:

Provider Business Practice Location Address
First Line	:	7683 SE 27TH ST
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2804
Country	:	US
Telephone Number	:	425-454-3194
Fax Number	:

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/08/2007

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