Provider Demographics
NPI:1457338691
Name:GJERSWOLD, MEGHIN MARIE
Entity Type:Individual
Prefix:
First Name:MEGHIN
Middle Name:MARIE
Last Name:GJERSWOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2002
Mailing Address - Country:US
Mailing Address - Phone:425-277-0212
Mailing Address - Fax:
Practice Address - Street 1:275 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2002
Practice Address - Country:US
Practice Address - Phone:425-277-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR00052256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist