Provider Demographics
NPI:1326321001
Name:MULDROW, VICTORIA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:MULDROW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:13730 30TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3510
Mailing Address - Country:US
Mailing Address - Phone:813-785-4513
Mailing Address - Fax:
Practice Address - Street 1:20812 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8404
Practice Address - Country:US
Practice Address - Phone:425-398-0204
Practice Address - Fax:425-481-7845
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020659183500000X
WAPH60453350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist