Provider Demographics
NPI:1619231057
Name:WATERS, BARBARA (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 143RD ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3636
Mailing Address - Country:US
Mailing Address - Phone:425-787-2803
Mailing Address - Fax:
Practice Address - Street 1:22828 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5920
Practice Address - Country:US
Practice Address - Phone:425-778-2144
Practice Address - Fax:425-771-5420
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist