Provider Demographics
NPI:1205138609
Name:DE BRIERE, CHARLES BURKE (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BURKE
Last Name:DE BRIERE
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 1:14612 BEAR CREEK ROAD NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-7820
Mailing Address - Country:US
Mailing Address - Phone:425-681-1300
Mailing Address - Fax:
Practice Address - Street 1:14612 BEAR CREEK RD NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-7820
Practice Address - Country:US
Practice Address - Phone:425-681-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist