Provider Demographics
NPI:1346584307
Name:GOSSER, RENA (PHARMD)
Entity Type:Individual
Prefix:
First Name:RENA
Middle Name:
Last Name:GOSSER
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 1:4333 BROOKLYN AVE NE
Mailing Address - Street 2:BOX 359411
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-598-3152
Mailing Address - Fax:
Practice Address - Street 1:4333 BROOKLYN AVE NE
Practice Address - Street 2:BOX 359411
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-598-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60587141183500000X, 1835P1200X, 1835P2201X, 1835P0018X
WI16842-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care