Provider Demographics
NPI:1619231487
Name:MACALINO, JESSICA MARIE ULEP (CPHT)
Entity Type:Individual
Prefix:
First Name:JESSICA MARIE
Middle Name:ULEP
Last Name:MACALINO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 UNIVERSITY WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5809
Mailing Address - Country:US
Mailing Address - Phone:206-632-3514
Mailing Address - Fax:
Practice Address - Street 1:4344 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5809
Practice Address - Country:US
Practice Address - Phone:206-632-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60135177183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician