Provider Demographics
NPI:1942613823
Name:BROGAN, LORAINE (RPH)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16222 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1520
Mailing Address - Country:US
Mailing Address - Phone:425-741-8649
Mailing Address - Fax:425-741-3741
Practice Address - Street 1:16222 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1520
Practice Address - Country:US
Practice Address - Phone:425-741-8649
Practice Address - Fax:425-741-3741
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00015486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist