Provider Demographics
NPI:1134371602
Name:DEFFENBAUGH, MARCIA LEIGH (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:LEIGH
Last Name:DEFFENBAUGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:LEIGH
Other - Last Name:HULLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:101 N ELY ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2941
Mailing Address - Country:US
Mailing Address - Phone:509-783-1438
Mailing Address - Fax:509-783-3321
Practice Address - Street 1:101 N ELY ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2941
Practice Address - Country:US
Practice Address - Phone:509-783-1438
Practice Address - Fax:509-783-3321
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist