Provider Demographics
NPI:1801334305
Name:EWING, WILLIAM (BSP , BSC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:EWING
Suffix:
Gender:M
Credentials:BSP , BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3987
Mailing Address - Country:US
Mailing Address - Phone:206-782-6354
Mailing Address - Fax:
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3987
Practice Address - Country:US
Practice Address - Phone:206-782-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00042714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist