Provider Demographics
NPI:1780951491
Name:FOO, IRENE Y (RPH)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:Y
Last Name:FOO
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 1:23422 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2718
Mailing Address - Country:US
Mailing Address - Phone:206-878-3900
Mailing Address - Fax:206-878-1114
Practice Address - Street 1:23422 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2718
Practice Address - Country:US
Practice Address - Phone:206-878-3900
Practice Address - Fax:206-878-1114
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist