Provider Demographics
NPI:1881867273
Name:PRIMMER, PATRICIA L
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:PRIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:TEKOA
Mailing Address - State:WA
Mailing Address - Zip Code:99033
Mailing Address - Country:US
Mailing Address - Phone:509-284-3025
Mailing Address - Fax:509-284-3076
Practice Address - Street 1:124 N CROSBY
Practice Address - Street 2:
Practice Address - City:TEKOA
Practice Address - State:WA
Practice Address - Zip Code:99033
Practice Address - Country:US
Practice Address - Phone:509-284-3025
Practice Address - Fax:509-284-3076
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6022479Medicaid
WA1283280001Medicare NSC