Provider Demographics
NPI:1699174672
Name:TATE, JESSICA D (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:D
Last Name:TATE
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 1:325 RHODORA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9276
Mailing Address - Country:US
Mailing Address - Phone:818-723-0615
Mailing Address - Fax:
Practice Address - Street 1:1115 13TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2012
Practice Address - Country:US
Practice Address - Phone:360-568-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60473390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist