Provider Demographics
NPI:1497976229
Name:BRIOSO, JENNIFER MAE V
Entity Type:Individual
Prefix:MS
First Name:JENNIFER MAE
Middle Name:V
Last Name:BRIOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5504
Mailing Address - Country:US
Mailing Address - Phone:425-416-2829
Mailing Address - Fax:
Practice Address - Street 1:730 LAKE DR
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5504
Practice Address - Country:US
Practice Address - Phone:425-416-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00067613183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician