Provider Demographics
NPI:1356717003
Name:QUIMBY, JEANNETTE BERNAY
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:BERNAY
Last Name:QUIMBY
Suffix:
Gender:F
Credentials:
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 578
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98322-0578
Mailing Address - Country:US
Mailing Address - Phone:206-618-3059
Mailing Address - Fax:
Practice Address - Street 1:4545 PT FSDICK DR NW STE 260
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1700
Practice Address - Country:US
Practice Address - Phone:253-530-8160
Practice Address - Fax:253-530-8163
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR 60471611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist