Provider Demographics
NPI:1659640506
Name:TRA, PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:TRA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12405 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8032
Mailing Address - Country:US
Mailing Address - Phone:425-822-9202
Mailing Address - Fax:
Practice Address - Street 1:12405 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8032
Practice Address - Country:US
Practice Address - Phone:425-822-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60169551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist