Provider Demographics
NPI:1104957950
Name:MAROVICH, DEBRA M (RPH)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:MAROVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 266TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7953
Mailing Address - Country:US
Mailing Address - Phone:425-837-0123
Mailing Address - Fax:
Practice Address - Street 1:3066 ISSAQUAH PINE LAKE RD SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7253
Practice Address - Country:US
Practice Address - Phone:425-391-1419
Practice Address - Fax:425-391-8361
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist