Provider Demographics
NPI:1760939052
Name:ITO, EMILIE MIKA (RPH)
Entity Type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:MIKA
Last Name:ITO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14118 SE 61ST PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4375
Mailing Address - Country:US
Mailing Address - Phone:425-691-0770
Mailing Address - Fax:
Practice Address - Street 1:14118 SE 61ST PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-4375
Practice Address - Country:US
Practice Address - Phone:425-691-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60667400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist