Provider Demographics
NPI:1386263820
Name:GURRAD, DENEICE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DENEICE
Middle Name:
Last Name:GURRAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 KLIPSUN LN SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7937
Mailing Address - Country:US
Mailing Address - Phone:360-790-1891
Mailing Address - Fax:
Practice Address - Street 1:90 SE KLAH CHE MIN DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9216
Practice Address - Country:US
Practice Address - Phone:360-432-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist