Provider Demographics
NPI:1679156624
Name:ADELSTEIN, CAMILLIA LILY
Entity Type:Individual
Prefix:
First Name:CAMILLIA
Middle Name:LILY
Last Name:ADELSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-0862
Mailing Address - Country:US
Mailing Address - Phone:425-345-1670
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPDWY STE 500
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5435
Practice Address - Country:US
Practice Address - Phone:425-514-0620
Practice Address - Fax:425-348-3041
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAV61008663183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician