Provider Demographics
NPI:1730448572
Name:YTREEIDE, RICHARD L (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:YTREEIDE
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 1:18800 142ND AVE NE
Mailing Address - Street 2:#4B
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8218
Mailing Address - Country:US
Mailing Address - Phone:425-455-2123
Mailing Address - Fax:425-908-7363
Practice Address - Street 1:18800 142ND AVE NE
Practice Address - Street 2:#4B
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8218
Practice Address - Country:US
Practice Address - Phone:425-455-2123
Practice Address - Fax:425-908-7363
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000108061835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00010806OtherLICENCE