Provider Demographics
NPI:1134341415
Name:HEBERT, JOHN F (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:HEBERT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66575
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0575
Mailing Address - Country:US
Mailing Address - Phone:206-243-5001
Mailing Address - Fax:206-299-3008
Practice Address - Street 1:18156 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98166-3720
Practice Address - Country:US
Practice Address - Phone:206-243-5001
Practice Address - Fax:206-299-3008
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU200007Medicare ID - Type Unspecified