Provider Demographics
NPI:1548244031
Name:DE FLORA-ROSS, MICHELE YVONNE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:YVONNE
Last Name:DE FLORA-ROSS
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 S STAR LAKE RD
Mailing Address - Street 2:25-203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-3406
Mailing Address - Country:US
Mailing Address - Phone:253-839-1744
Mailing Address - Fax:
Practice Address - Street 1:12946 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7940
Practice Address - Country:US
Practice Address - Phone:253-631-6874
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00018350183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician