Provider Demographics
NPI:1689951071
Name:SUMMERRISE, CELITA LOUISE
Entity Type:Individual
Prefix:
First Name:CELITA
Middle Name:LOUISE
Last Name:SUMMERRISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELITA
Other - Middle Name:LOUISE
Other - Last Name:SUMMERRISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:4045 S 212TH CT
Mailing Address - Street 2:UNIT C
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:206-683-4765
Mailing Address - Fax:
Practice Address - Street 1:27520 COVINGTON WAY SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042
Practice Address - Country:US
Practice Address - Phone:253-796-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60240463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist