Provider Demographics
NPI:1669877601
Name:MUHAT, MERIVIC (PHARMD)
Entity type:Individual
Prefix:
First Name:MERIVIC
Middle Name:
Last Name:MUHAT
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 1:415 85TH DR SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7377
Mailing Address - Country:US
Mailing Address - Phone:425-789-3364
Mailing Address - Fax:425-789-3365
Practice Address - Street 1:1605 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2838
Practice Address - Country:US
Practice Address - Phone:425-789-3364
Practice Address - Fax:425-789-3365
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00040674OtherWASHINGTON STATE PHARMACIST LICENSE