Provider Demographics
NPI:1184496069
Name:POCH, STEPHANIE PESEY (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PESEY
Last Name:POCH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 196TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7189
Mailing Address - Country:US
Mailing Address - Phone:425-773-8021
Mailing Address - Fax:
Practice Address - Street 1:8131 W BOSTIAN RD
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-5027
Practice Address - Country:US
Practice Address - Phone:425-951-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61451631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist