| NPI | 1790178010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER D ROGERS Owner 206-486-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 60048520) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2022-08-04 |