Provider Demographics
NPI:1134227630
Name:QUESSENBERRY, PATRICIA (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:QUESSENBERRY
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 1:1460 ROMA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7890
Mailing Address - Country:US
Mailing Address - Phone:360-734-5413
Mailing Address - Fax:360-734-1454
Practice Address - Street 1:1414 MEADOR AVE
Practice Address - Street 2:SUITE H-102
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5833
Practice Address - Country:US
Practice Address - Phone:360-734-5413
Practice Address - Fax:360-734-1454
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist