Provider Demographics
NPI:1801865126
Name:MEHLBERG, JENNIFER CAREY (PHARMD, CACP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAREY
Last Name:MEHLBERG
Suffix:
Gender:F
Credentials:PHARMD, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2304
Mailing Address - Country:US
Mailing Address - Phone:206-598-7566
Mailing Address - Fax:206-598-2717
Practice Address - Street 1:4245 ROOSEVELT WAY NE
Practice Address - Street 2:PHARMACY, BOX 354735
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-5579
Practice Address - Fax:206-598-2717
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000194591835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist