Provider Demographics
NPI:1831492347
Name:LOESELL, MARK A (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:LOESELL
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 1:7129 130TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-7698
Mailing Address - Country:US
Mailing Address - Phone:425-379-2435
Mailing Address - Fax:
Practice Address - Street 1:16616 TWIN LAKES AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4701
Practice Address - Country:US
Practice Address - Phone:360-652-4539
Practice Address - Fax:360-652-4536
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist