Provider Demographics
NPI:1831524214
Name:TIELKE, VERONICA (RPH)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:TIELKE
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 1:16421 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5121
Mailing Address - Country:US
Mailing Address - Phone:425-922-8835
Mailing Address - Fax:
Practice Address - Street 1:1120 112TH AVE NE
Practice Address - Street 2:SUITE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4500
Practice Address - Country:US
Practice Address - Phone:425-688-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist