Provider Demographics
NPI:1982688149
Name:ISARA, BARRY J (CPT)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:J
Last Name:ISARA
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17521 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3603
Mailing Address - Country:US
Mailing Address - Phone:206-367-2325
Mailing Address - Fax:
Practice Address - Street 1:2700 NE UNIVERSITY VILLAGE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5016
Practice Address - Country:US
Practice Address - Phone:206-525-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00039179183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician