Provider Demographics
NPI:1598097115
Name:MAIN, DENISE L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:MAIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 COOPER POINT RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5734
Mailing Address - Country:US
Mailing Address - Phone:360-570-8008
Mailing Address - Fax:360-570-9162
Practice Address - Street 1:1510 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5734
Practice Address - Country:US
Practice Address - Phone:360-570-8008
Practice Address - Fax:360-570-9162
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist