Provider Demographics
NPI:1912017062
Name:DE LEON-SMITH, CAROLINE MICHELLE (CPHT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MICHELLE
Last Name:DE LEON-SMITH
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22803 44TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5032
Mailing Address - Country:US
Mailing Address - Phone:425-771-3738
Mailing Address - Fax:425-776-1190
Practice Address - Street 1:22803 44TH AVE W
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5032
Practice Address - Country:US
Practice Address - Phone:425-771-3738
Practice Address - Fax:425-776-1190
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00063064183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician