Provider Demographics
NPI:1295740058
Name:SKIDMORE, STEVE (RPH)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 24TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2592
Mailing Address - Country:US
Mailing Address - Phone:360-293-2124
Mailing Address - Fax:360-293-0419
Practice Address - Street 1:1213 24TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2592
Practice Address - Country:US
Practice Address - Phone:360-293-2124
Practice Address - Fax:360-293-0419
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00021142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist