Provider Demographics
NPI:1316162654
Name:BERLIN, MANZAR G
Entity type:Individual
Prefix:MS
First Name:MANZAR
Middle Name:G
Last Name:BERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13370 NE 134TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5537
Mailing Address - Country:US
Mailing Address - Phone:425-823-2172
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:BOX#359912
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-5512
Practice Address - Fax:206-744-8538
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist