MEDICARE: MICHAEL SCOTT BOSTICK R.PH.

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	PH00010714	WA

General Provider Information

NPI Number	:	1922081496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SCOTT BOSTICK R.PH.

Provider Business Mailing Address
First Line	:	18923 131ST AVE SE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98058-7989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18923 131ST AVE SE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98058-7989
Country	:	US
Telephone Number	:	206-383-6885
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	01/06/2014

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