Provider Demographics
NPI:1750599817
Name:CHARVET-PEDERSON, JEANINE NOELETTE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:NOELETTE
Last Name:CHARVET-PEDERSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-1055
Mailing Address - Country:US
Mailing Address - Phone:509-865-5018
Mailing Address - Fax:
Practice Address - Street 1:117 S TOPPENISH AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1557
Practice Address - Country:US
Practice Address - Phone:509-865-2722
Practice Address - Fax:509-865-2329
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist