Provider Demographics
NPI:1902496987
Name:WEDOFF, JISOON ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JISOON
Middle Name:ALEXANDRA
Last Name:WEDOFF
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 1:7405 168TH AVE NE APT 627
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6292
Mailing Address - Country:US
Mailing Address - Phone:563-581-3380
Mailing Address - Fax:
Practice Address - Street 1:19191 N KELSEY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1459
Practice Address - Country:US
Practice Address - Phone:306-365-4036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61068693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist