Provider Demographics
NPI:1841962412
Name:MCCULLUM-ZEMPEL, CONNOR JADEN
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:JADEN
Last Name:MCCULLUM-ZEMPEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20430 33RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1543
Mailing Address - Country:US
Mailing Address - Phone:206-566-2987
Mailing Address - Fax:
Practice Address - Street 1:23028 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5080
Practice Address - Country:US
Practice Address - Phone:425-774-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician