Provider Demographics
NPI:1073820585
Name:BASTION, TRINA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:MARIE
Last Name:BASTION
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8242
Mailing Address - Country:US
Mailing Address - Phone:360-825-2558
Mailing Address - Fax:360-825-5941
Practice Address - Street 1:232 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-8242
Practice Address - Country:US
Practice Address - Phone:360-825-2558
Practice Address - Fax:360-825-5941
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 0056847183500000X
ORRPH-0008958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist