Provider Demographics
NPI:1710397021
Name:LIN, JIETONG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIETONG
Middle Name:
Last Name:LIN
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 1:219 PINEHURST DRIVE SW
Mailing Address - Street 2:APT 203
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:94538-5523
Mailing Address - Country:US
Mailing Address - Phone:510-299-1002
Mailing Address - Fax:
Practice Address - Street 1:219 PINEHURST DRIVE SW
Practice Address - Street 2:APT 203
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:94538-5523
Practice Address - Country:US
Practice Address - Phone:510-299-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60486258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist