Provider Demographics
NPI:1124164181
Name:LACOTTA, MARK W (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:LACOTTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NE 130TH LN STE 415
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7468
Mailing Address - Country:US
Mailing Address - Phone:425-899-2783
Mailing Address - Fax:
Practice Address - Street 1:12333 NE 130TH LN STE 415
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7468
Practice Address - Country:US
Practice Address - Phone:425-899-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057111183500000X
PARP036015L183500000X
AKPHAP1491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist