Provider Demographics
NPI:1104075589
Name:BLACK, JANET IRENE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:IRENE
Last Name:BLACK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:IRENE
Other - Last Name:BRAKEBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:4626 244TH PL SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029
Mailing Address - Country:US
Mailing Address - Phone:425-891-6657
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVENUE WEST
Practice Address - Street 2:SUITE 330 CAREER STAFF UNLIMITED
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:800-766-0122
Practice Address - Fax:866-835-5848
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000010498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00010498OtherPHARMACIST LICENSE