Provider Demographics
NPI:1861767501
Name:HARTSHORN, MARY DORDI (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DORDI
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13907 55TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9449
Mailing Address - Country:US
Mailing Address - Phone:425-379-7487
Mailing Address - Fax:
Practice Address - Street 1:10200 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4256
Practice Address - Country:US
Practice Address - Phone:425-379-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist