Provider Demographics
NPI:1578965380
Name:ENGRUM, CASSANDRA
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:ENGRUM
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 1:16960 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1481
Mailing Address - Country:US
Mailing Address - Phone:206-601-8411
Mailing Address - Fax:
Practice Address - Street 1:16960 3RD AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1481
Practice Address - Country:US
Practice Address - Phone:206-601-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVB 00044857183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician