Provider Demographics
NPI:1699058412
Name:COLIGNON, MARIETA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARIETA
Middle Name:M
Last Name:COLIGNON
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 1:10000 MICKELBERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8302
Mailing Address - Country:US
Mailing Address - Phone:360-308-2116
Mailing Address - Fax:360-308-2125
Practice Address - Street 1:10000 MICKELBERRY RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8302
Practice Address - Country:US
Practice Address - Phone:360-308-2116
Practice Address - Fax:360-308-2125
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist