Provider Demographics
NPI:1255652350
Name:MIDDLETON, CORRIE J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:J
Last Name:MIDDLETON
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 1:11229 86TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-6207
Mailing Address - Country:US
Mailing Address - Phone:425-220-9957
Mailing Address - Fax:
Practice Address - Street 1:303 91ST AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2541
Practice Address - Country:US
Practice Address - Phone:425-335-4513
Practice Address - Fax:425-334-7814
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0060045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist