Provider Demographics
NPI:1497297022
Name:BENIYA, RISA
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:BENIYA
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 1:5700 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8914
Mailing Address - Country:US
Mailing Address - Phone:425-391-1765
Mailing Address - Fax:
Practice Address - Street 1:5700 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8914
Practice Address - Country:US
Practice Address - Phone:425-391-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60270782183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician