Provider Demographics
NPI:1306110895
Name:FRIDRIKSSON, TABITHA LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:LYNN
Last Name:FRIDRIKSSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:TABITHA
Other - Middle Name:LYNN
Other - Last Name:VOILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14406 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1448
Mailing Address - Country:US
Mailing Address - Phone:360-571-4271
Mailing Address - Fax:360-571-3095
Practice Address - Street 1:14406 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1448
Practice Address - Country:US
Practice Address - Phone:360-571-4271
Practice Address - Fax:360-571-3095
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00022619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist