Provider Demographics
NPI:1184830945
Name:LOOSE, DARIN JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:JAMES
Last Name:LOOSE
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 1:3208 LADY FERN LOOP NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 TROSPER RD SW
Practice Address - Street 2:FRED MEYER PHARMACY
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7375
Practice Address - Country:US
Practice Address - Phone:360-753-7933
Practice Address - Fax:360-753-7927
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00043323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist