Provider Demographics
NPI:1407064363
Name:PAK, ANGEL (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 107TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2070
Mailing Address - Country:US
Mailing Address - Phone:206-330-7207
Mailing Address - Fax:
Practice Address - Street 1:720 7TH AVE
Practice Address - Street 2:#100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-838-6070
Practice Address - Fax:206-838-9775
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA59638183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA59683OtherTECHNICIAN LICENSE