Provider Demographics
NPI:1194775577
Name:CARLSON, GAIL ESTELLE (CPHT, PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:ESTELLE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:CPHT, PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NW GILMAN BLVD.
Mailing Address - Street 2:STE. #107
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:425-392-8650
Mailing Address - Fax:425-391-8624
Practice Address - Street 1:450 NW GILMAN BLVD.
Practice Address - Street 2:STE. #107
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-392-8650
Practice Address - Fax:425-391-8624
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00051799183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician