Provider Demographics
NPI:1952675035
Name:MATSUURA, NANCY LIU (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LIU
Last Name:MATSUURA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2310 LONGFIBRE RD
Mailing Address - Street 2:
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1513
Mailing Address - Country:US
Mailing Address - Phone:509-454-5249
Mailing Address - Fax:509-454-5246
Practice Address - Street 1:2310 LONGFIBRE RD
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-1513
Practice Address - Country:US
Practice Address - Phone:509-454-5249
Practice Address - Fax:509-454-5246
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00045509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00045509OtherSTATE PHARMACIST LICENSE