Provider Demographics
NPI:1467441097
Name:MARK, JOSHUA L (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:MARK
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 69TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6032
Mailing Address - Country:US
Mailing Address - Phone:702-539-7920
Mailing Address - Fax:
Practice Address - Street 1:1221 MADISON ST STE 444
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-386-6215
Practice Address - Fax:206-386-2134
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00052219183500000X
NV173521835X0200X
NMRP00006827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00052219OtherPHARMACIST LICENSE