Provider Demographics
NPI:1316208457
Name:BURCH-FERNANDES, PAMELA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:BURCH-FERNANDES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 145TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5593
Mailing Address - Country:US
Mailing Address - Phone:425-653-2431
Mailing Address - Fax:425-653-2596
Practice Address - Street 1:1510 145TH PL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5593
Practice Address - Country:US
Practice Address - Phone:425-653-2431
Practice Address - Fax:425-653-2596
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6025217Medicaid