Provider Demographics
NPI:1215247275
Name:BAREM, LEIF ERNST
Entity type:Individual
Prefix:MR
First Name:LEIF
Middle Name:ERNST
Last Name:BAREM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17193 W BIG LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8375
Mailing Address - Country:US
Mailing Address - Phone:360-757-5702
Mailing Address - Fax:360-757-5709
Practice Address - Street 1:1725 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3223
Practice Address - Country:US
Practice Address - Phone:360-757-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist