Provider Demographics
NPI:1326378092
Name:KLAASKATE, GERIANN BREDICE (RPH)
Entity Type:Individual
Prefix:
First Name:GERIANN
Middle Name:BREDICE
Last Name:KLAASKATE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 MUKILTEO SPEEDWAY
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4743
Mailing Address - Country:US
Mailing Address - Phone:425-315-9213
Mailing Address - Fax:425-315-9553
Practice Address - Street 1:10200 MUKILTEO SPEEDWAY
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4743
Practice Address - Country:US
Practice Address - Phone:425-315-9213
Practice Address - Fax:425-315-9553
Is Sole Proprietor?:No
Enumeration Date:2010-01-01
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist