Provider Demographics
NPI:1689804288
Name:TAKAHASHI, MARIAN MIDORI (RPH)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:MIDORI
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:MIDORI
Other - Last Name:TAKAHASHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:26602 164TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8244
Mailing Address - Country:US
Mailing Address - Phone:253-630-6013
Mailing Address - Fax:
Practice Address - Street 1:26004 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7677
Practice Address - Country:US
Practice Address - Phone:425-251-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist