Provider Demographics
NPI:1568441384
Name:GRINGAUZ, VIKTORIYA
Entity Type:Individual
Prefix:MISS
First Name:VIKTORIYA
Middle Name:
Last Name:GRINGAUZ
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 1:4771 148TH AVE NE
Mailing Address - Street 2:N207
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3072
Mailing Address - Country:US
Mailing Address - Phone:206-779-5379
Mailing Address - Fax:
Practice Address - Street 1:8860 161ST AVE NE
Practice Address - Street 2:S 1
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3582
Practice Address - Country:US
Practice Address - Phone:206-763-2626
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00041971183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician