Provider Demographics
NPI:1740535475
Name:BUERHAUS, REBECCA JO (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:BUERHAUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 W MUKILTEO BLVD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1519
Mailing Address - Country:US
Mailing Address - Phone:425-330-9928
Mailing Address - Fax:
Practice Address - Street 1:4919 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2828
Practice Address - Country:US
Practice Address - Phone:425-259-3444
Practice Address - Fax:425-339-2212
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000433216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist