Provider Demographics
NPI:1821384561
Name:TAGHON, STEVEN RAY (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RAY
Last Name:TAGHON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NW GILMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5357
Mailing Address - Country:US
Mailing Address - Phone:425-507-1020
Mailing Address - Fax:425-507-1020
Practice Address - Street 1:755 NW GILMAN BLVD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5357
Practice Address - Country:US
Practice Address - Phone:425-507-1020
Practice Address - Fax:425-507-1020
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00039278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028112Medicaid