Provider Demographics
NPI:1093061079
Name:CRUZ, JOSE ALBERTO (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALBERTO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BOREN AVE APT 409
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2771
Mailing Address - Country:US
Mailing Address - Phone:954-260-3259
Mailing Address - Fax:
Practice Address - Street 1:1330 BOREN AVE APT 409
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2771
Practice Address - Country:US
Practice Address - Phone:954-260-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60280256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist