Provider Demographics
NPI:1013042332
Name:IRVINE, BETHANY A (PHARMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:IRVINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356015
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6015
Mailing Address - Country:US
Mailing Address - Phone:206-598-6060
Mailing Address - Fax:206-598-6075
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356015
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6015
Practice Address - Country:US
Practice Address - Phone:206-598-6060
Practice Address - Fax:206-598-6075
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00046230183500000X
CA52123183500000X
AZS12684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist