Provider Demographics
NPI:1366025769
Name:YAHAGI-VON TERSCH, KRISTENE
Entity Type:Individual
Prefix:
First Name:KRISTENE
Middle Name:
Last Name:YAHAGI-VON TERSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 FACTORIA SQUARE MALL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1264
Mailing Address - Country:US
Mailing Address - Phone:425-644-2925
Mailing Address - Fax:425-643-1542
Practice Address - Street 1:3905 FACTORIA SQUARE MALL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1264
Practice Address - Country:US
Practice Address - Phone:425-644-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60942838183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician