1265087654 NPI number — VALORIE SWENSEN RPH, BCPS

Table of content: VALORIE SWENSEN RPH, BCPS (NPI 1265087654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265087654 NPI number — VALORIE SWENSEN RPH, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWENSEN
Provider First Name:
VALORIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH, BCPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICKELSON
Provider Other First Name:
VALORIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265087654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98228-2456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-647-4548
Provider Business Mailing Address Fax Number:
360-647-4548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98229-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-393-2228
Provider Business Practice Location Address Fax Number:
360-647-4548
Provider Enumeration Date:
08/02/2019

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: 1835P0018X , with the licence number:  41398 , 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)

  • Identifier: 41398 . This is a "PHARMACIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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