Provider Demographics
NPI:1417258542
Name:FRALEY, JILL SUSANNE (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUSANNE
Last Name:FRALEY
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 1:7601 EVERGREEN WAY STE A1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6433
Mailing Address - Country:US
Mailing Address - Phone:425-355-9303
Mailing Address - Fax:425-355-9304
Practice Address - Street 1:7601 EVERGREEN WAY STE A1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6433
Practice Address - Country:US
Practice Address - Phone:425-355-9303
Practice Address - Fax:425-355-9304
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00010307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist