Provider Demographics
NPI:1437366275
Name:DAFFORN, MARTIN LEE (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:LEE
Last Name:DAFFORN
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 1:2512 126TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1548
Mailing Address - Country:US
Mailing Address - Phone:425-256-1543
Mailing Address - Fax:
Practice Address - Street 1:2512 126TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1548
Practice Address - Country:US
Practice Address - Phone:425-256-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist