Provider Demographics
NPI:1043280472
Name:SELBYG, AMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SELBYG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20455 1ST AVE NE APT M303
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9347
Mailing Address - Country:US
Mailing Address - Phone:360-620-5283
Mailing Address - Fax:
Practice Address - Street 1:1 BOONE RD
Practice Address - Street 2:NAVAL HOSPITAL BREMERTON - PHARMACY
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-1894
Practice Address - Country:US
Practice Address - Phone:360-475-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist