Provider Demographics
NPI:1134245798
Name:OOMMEN, ANU (RPH)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:
Last Name:OOMMEN
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 1:1114 241ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-8156
Mailing Address - Country:US
Mailing Address - Phone:425-369-1215
Mailing Address - Fax:
Practice Address - Street 1:11511 NE 10 TH STREET
Practice Address - Street 2:BELLEVUE MEDICAL CENTER
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-502-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00063509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist