Provider Demographics
NPI:1134430077
Name:COONS, VICTORIA LOU (RPH)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LOU
Last Name:COONS
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 1:12506 16TH ST NE APT A3
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7725
Mailing Address - Country:US
Mailing Address - Phone:425-374-8692
Mailing Address - Fax:
Practice Address - Street 1:18906 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1415
Practice Address - Country:US
Practice Address - Phone:360-794-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist