Provider Demographics
NPI:1346644259
Name:DIPASQUA, GUY (RPH)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:DIPASQUA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11594 174TH CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1639
Mailing Address - Country:US
Mailing Address - Phone:425-786-8798
Mailing Address - Fax:360-752-6437
Practice Address - Street 1:2211 RIMLAND DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5664
Practice Address - Country:US
Practice Address - Phone:360-650-8204
Practice Address - Fax:360-752-6437
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03212507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH362734OtherNABP