Basic Information
| Provider Information | |||||||||
| NPI: | 1043615842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IENNA | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4420 MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606471611 | ||||||||
| FaxNumber: | 3606472316 | ||||||||
| Practice Location | |||||||||
| Address1: | 4420 MERIDIAN ST | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606471611 | ||||||||
| FaxNumber: | 3606472316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2014 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18381 | TX | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH60040384 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.