Provider Demographics
NPI:1588910533
Name:UPENIEKS, MARA ILZE (RPH)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ILZE
Last Name:UPENIEKS
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 1:800 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5391
Mailing Address - Country:US
Mailing Address - Phone:800-607-6861
Mailing Address - Fax:425-313-6730
Practice Address - Street 1:800 LAKE DR
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5391
Practice Address - Country:US
Practice Address - Phone:800-607-6861
Practice Address - Fax:425-313-6730
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist