Provider Demographics
NPI:1962683540
Name:THELEN, RENEE VIRGINIA (PHARMACY TECH)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:VIRGINIA
Last Name:THELEN
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2012
Mailing Address - Country:US
Mailing Address - Phone:360-568-0548
Mailing Address - Fax:360-568-5151
Practice Address - Street 1:1115 13TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2012
Practice Address - Country:US
Practice Address - Phone:360-568-0548
Practice Address - Fax:360-568-5151
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00066731247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other