Provider Demographics
NPI:1992789150
Name:SKATULA, DAVID M (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:SKATULA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 85TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-784-7601
Mailing Address - Fax:206-783-8938
Practice Address - Street 1:120 N 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-3602
Practice Address - Country:US
Practice Address - Phone:206-784-7601
Practice Address - Fax:206-783-8938
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist