Provider Demographics
NPI:1235502592
Name:QUIAMAS, REDORA
Entity Type:Individual
Prefix:
First Name:REDORA
Middle Name:
Last Name:QUIAMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REDORA
Other - Middle Name:
Other - Last Name:HOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26823 225TH PL SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6048
Mailing Address - Country:US
Mailing Address - Phone:206-355-0537
Mailing Address - Fax:
Practice Address - Street 1:10712 SE CARR RD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5826
Practice Address - Country:US
Practice Address - Phone:425-277-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60510723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist