Provider Demographics
NPI:1043504822
Name:SAMBERG, TRISTINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRISTINE
Middle Name:
Last Name:SAMBERG
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 1:405 SE EVERETT MALL WAY
Mailing Address - Street 2:T-0337
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3243
Mailing Address - Country:US
Mailing Address - Phone:425-353-7967
Mailing Address - Fax:425-353-7967
Practice Address - Street 1:405 SE EVERETT MALL WAY
Practice Address - Street 2:T-0337
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3243
Practice Address - Country:US
Practice Address - Phone:425-353-7967
Practice Address - Fax:425-353-7967
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60098185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist