Provider Demographics
NPI:1588928311
Name:MCINTYRE, BRYNNA
Entity type:Individual
Prefix:
First Name:BRYNNA
Middle Name:
Last Name:MCINTYRE
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 1:5006 132ND ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9517
Mailing Address - Country:US
Mailing Address - Phone:425-357-6162
Mailing Address - Fax:425-357-6125
Practice Address - Street 1:5006 132ND ST SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9517
Practice Address - Country:US
Practice Address - Phone:425-357-6162
Practice Address - Fax:425-357-6125
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60197839183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVA60197839OtherWA STATE DEPT OF HEALTH