Provider Demographics
NPI:1073668471
Name:MAR-BURBIDGE, JUDI LEE (PHARMD, FASCP)
Entity type:Individual
Prefix:DR
First Name:JUDI
Middle Name:LEE
Last Name:MAR-BURBIDGE
Suffix:
Gender:F
Credentials:PHARMD, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15534 BAGLEY PL N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6031
Mailing Address - Country:US
Mailing Address - Phone:206-364-1846
Mailing Address - Fax:425-806-7725
Practice Address - Street 1:12303 NE 130TH LN STE 210
Practice Address - Street 2:EVERGREEN HOSPITAL PROFESSIONAL CENTER PHARMACY
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3060
Practice Address - Country:US
Practice Address - Phone:425-899-2792
Practice Address - Fax:425-899-2795
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist