Provider Demographics
NPI:1417163031
Name:POYSSICK, DIAN ALETHA (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIAN
Middle Name:ALETHA
Last Name:POYSSICK
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 1:2767 NE ALDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9240
Mailing Address - Country:US
Mailing Address - Phone:360-297-4719
Mailing Address - Fax:
Practice Address - Street 1:8196 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346
Practice Address - Country:US
Practice Address - Phone:360-297-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist