Provider Demographics
NPI:1881978765
Name:KRISLOCK, RACHEL CHANTRY WAITE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:CHANTRY WAITE
Last Name:KRISLOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:CHANTRY
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MAIL STOP: H3-PL
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111
Mailing Address - Country:US
Mailing Address - Phone:206-223-6852
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE MAIL STOP H3-PL
Practice Address - Street 2:VIRGINIA MASON MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98111
Practice Address - Country:US
Practice Address - Phone:206-223-6852
Practice Address - Fax:206-341-0867
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60228192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist