Provider Demographics
NPI:1427286970
Name:GROOTHUIS, ELIZA ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:ANNE
Last Name:GROOTHUIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EASTLAKE AVE E # G5-900
Mailing Address - Street 2:P.O. BOX 19023
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4405
Mailing Address - Country:US
Mailing Address - Phone:206-288-1044
Mailing Address - Fax:206-288-6759
Practice Address - Street 1:825 EASTLAKE AVE E # G5-900
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-288-1044
Practice Address - Fax:206-288-6759
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00070498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist