Provider Demographics
NPI:1851710495
Name:WESTERN WASHINGTON MEDICAL GROUP
Entity Type:Organization
Organization Name:WESTERN WASHINGTON MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESEARCH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:425-225-2760
Mailing Address - Street 1:12728 19TH AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6526
Mailing Address - Country:US
Mailing Address - Phone:425-225-2760
Mailing Address - Fax:425-252-1118
Practice Address - Street 1:12728 19TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-225-2760
Practice Address - Fax:425-252-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000207161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00020716OtherPHARMACIST LICENSE