Provider Demographics
NPI:1275896912
Name:FILLER, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 WHITMAN LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2245
Mailing Address - Country:US
Mailing Address - Phone:360-438-6314
Mailing Address - Fax:360-438-6402
Practice Address - Street 1:4775 WHITMAN LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-2245
Practice Address - Country:US
Practice Address - Phone:360-438-6314
Practice Address - Fax:360-438-6402
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist