Provider Demographics
NPI:1639455694
Name:HEGTVEDT, BINA JUNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BINA
Middle Name:JUNE
Last Name:HEGTVEDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8445
Mailing Address - Country:US
Mailing Address - Phone:360-981-6882
Mailing Address - Fax:
Practice Address - Street 1:490 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3342
Practice Address - Country:US
Practice Address - Phone:360-682-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60237876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist