Provider Demographics
NPI:1578536371
Name:WHITE, MARLO MARIE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:MARIE
Last Name:WHITE
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 1:44125 FIR RD
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-9365
Mailing Address - Country:US
Mailing Address - Phone:360-793-1649
Mailing Address - Fax:
Practice Address - Street 1:1115 13TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2012
Practice Address - Country:US
Practice Address - Phone:360-568-0548
Practice Address - Fax:360-568-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00019839183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVA00019839OtherSTATE LICENSE NUMBER