Most Relevant Information
Provider Data
| NPI Number: | 1003461260 |
| Provider Name: | MIRACLE RUTH EDISON PH60920591 |
| Entity Type: | Individual |
| Taxonomy Code: | 1835P0018X |
| Specialty: | Pharmacist |
| License Number: | 60920591 |
Most Important Dates
| Enumeration Date: | 08/05/2019 |
| Last Updated: | 08/05/2019 |
Provider Practice Location
3620 FACTORIA BLVD SE
BELLEVUE
WA
980066128
Practice Location Phone/Fax
| Phone: | 4256447529 |
| Fax: |
Provider Mailing Location
3620 FACTORIA BLVD SE
BELLEVUE
WA
980066128
Provider Mailing Phone/Fax
| Phone: | 4256447529 |
| Fax: | 4255025482 |