Provider Demographics
NPI:1659605038
Name:PATIN, MICHAEL ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:PATIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:PATIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:700 S SOUTH MAIN STREET
Mailing Address - Street 2:700 SOUTH MAIN STREET
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-925-4232
Mailing Address - Fax:509-925-6065
Practice Address - Street 1:700 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926
Practice Address - Country:US
Practice Address - Phone:509-925-4232
Practice Address - Fax:509-925-6065
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA19191183500000X
WA000019191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist