Provider Demographics
NPI:1134497241
Name:PERSON, STORMIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:STORMIE
Middle Name:
Last Name:PERSON
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 1:17126 70TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6193
Mailing Address - Country:US
Mailing Address - Phone:360-691-7673
Mailing Address - Fax:360-691-7054
Practice Address - Street 1:17126 70TH ST NE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-6193
Practice Address - Country:US
Practice Address - Phone:360-691-7673
Practice Address - Fax:360-691-7054
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist