Provider Demographics
NPI:1871878306
Name:DERRIG, JAMES PETER (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PETER
Last Name:DERRIG
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 1:6432 STATE HIGHWAY 303 NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3714
Mailing Address - Country:US
Mailing Address - Phone:360-307-8741
Mailing Address - Fax:360-307-8745
Practice Address - Street 1:6432 STATE HIGHWAY 303 NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3714
Practice Address - Country:US
Practice Address - Phone:360-307-8741
Practice Address - Fax:360-307-8745
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist