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MR. BERT GERALD HATHAWAY PHARMACIST

>> Pharmacist >> Pharmacy Service Providers

Registrant NPI Number: 1538362447

Individual Registrant:
MR. BERT GERALD HATHAWAY PHARMACIST
Gender: M
Sole Proprietor

Location and contact information for practice:
19401 40TH AVENUE WEST SUITE 330 LINNWOOD, WA 98036 US
Tel: 360-374-5169  Fax: --

Contact information for business:
BOX 2270  FORKS, WA 98331-2270 US
Tel: 360-374-5169  Fax: --

Registration Information:
NPI: 1538362447
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y183500000XPharmacy Service Providers
Pharmacist
WAPH00008052

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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