1073668471 NPI number — DR. JUDI LEE MAR-BURBIDGE PHARMD, FASCP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073668471 NPI number — DR. JUDI LEE MAR-BURBIDGE PHARMD, FASCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAR-BURBIDGE
Provider First Name:
JUDI
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, FASCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073668471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15534 BAGLEY PL N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-6031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-364-1846
Provider Business Mailing Address Fax Number:
425-806-7725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12303 NE 130TH LN STE 210
Provider Second Line Business Practice Location Address:
EVERGREEN HOSPITAL PROFESSIONAL CENTER PHARMACY
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-2792
Provider Business Practice Location Address Fax Number:
425-899-2795
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH00011470 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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