Provider Demographics
NPI:1871883272
Name:SMITH, DINAH SUSAN (RPH)
Entity type:Individual
Prefix:MS
First Name:DINAH
Middle Name:SUSAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4319 ISSAQUAH PINE LAKE RD SE
Mailing Address - Street 2:UNIT 906
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5274
Mailing Address - Country:US
Mailing Address - Phone:425-391-6962
Mailing Address - Fax:
Practice Address - Street 1:4401 4TH AVE S
Practice Address - Street 2:COSTCO #01
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2311
Practice Address - Country:US
Practice Address - Phone:206-682-6244
Practice Address - Fax:206-403-2020
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPH00010302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist