Provider Demographics
NPI:1912281346
Name:HARTWIGSEN, REBECCA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:HARTWIGSEN
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 1:27520 COVINGTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-9100
Mailing Address - Country:US
Mailing Address - Phone:253-796-1011
Mailing Address - Fax:253-796-1008
Practice Address - Street 1:27520 COVINGTON WAY SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-9100
Practice Address - Country:US
Practice Address - Phone:253-796-1011
Practice Address - Fax:253-796-1008
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019056183500000X
MDPH00019056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist