Provider Demographics
NPI:1952733602
Name:POOLE, JUSTIN SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SCOTT
Last Name:POOLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 BOTHELL EVERETT HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1660
Mailing Address - Country:US
Mailing Address - Phone:425-402-6079
Mailing Address - Fax:
Practice Address - Street 1:18001 BOTHELL EVERETT HWY STE 101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-1660
Practice Address - Country:US
Practice Address - Phone:425-402-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60386227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60386227OtherWASHINGTON STATE LICENSE