Provider Demographics
NPI:1518663368
Name:WINDE, VIRGINIA L (PRH)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:WINDE
Suffix:
Gender:F
Credentials:PRH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4147
Mailing Address - Country:US
Mailing Address - Phone:425-261-3530
Mailing Address - Fax:425-261-3536
Practice Address - Street 1:916 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4147
Practice Address - Country:US
Practice Address - Phone:425-261-3530
Practice Address - Fax:425-261-3536
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist