Provider Demographics
NPI:1679557938
Name:PRITZL, SHELLEY LOU
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LOU
Last Name:PRITZL
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 1:4727 DENVER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2316
Mailing Address - Country:US
Mailing Address - Phone:360-403-7591
Mailing Address - Fax:360-403-7591
Practice Address - Street 1:6602 64TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4834
Practice Address - Country:US
Practice Address - Phone:360-658-5218
Practice Address - Fax:360-658-5549
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00050796183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician