Provider Demographics
NPI:1194077438
Name:WILLAMS, GRETCHEN (RPH)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:WILLAMS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4025 DELRIDGE WAY SW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1249
Mailing Address - Country:US
Mailing Address - Phone:206-763-2626
Mailing Address - Fax:206-763-2062
Practice Address - Street 1:4025 DELRIDGE WAY SW
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1249
Practice Address - Country:US
Practice Address - Phone:206-763-2626
Practice Address - Fax:206-763-2062
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00013613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist