Provider Demographics
NPI:1558763862
Name:OSALLA, JACKIEMAY CATHERINE
Entity Type:Individual
Prefix:
First Name:JACKIEMAY CATHERINE
Middle Name:
Last Name:OSALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHN CARLO
Other - Middle Name:ALFEREZ
Other - Last Name:OSALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24313 118TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-9202
Mailing Address - Country:US
Mailing Address - Phone:415-509-6181
Mailing Address - Fax:
Practice Address - Street 1:2345 42ND AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2513
Practice Address - Country:US
Practice Address - Phone:206-932-7437
Practice Address - Fax:206-932-7440
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician