Provider Demographics
NPI:1770584997
Name:ENGEL, THOMAS L (RPHMBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:ENGEL
Suffix:
Gender:M
Credentials:RPHMBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:#112
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-365-2255
Mailing Address - Fax:206-368-1128
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:#112
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-365-2255
Practice Address - Fax:206-368-1128
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24072Medicare ID - Type UnspecifiedFOR FLU ADMIN