Basic Information
| Provider Information | |||||||||
| NPI: | 1295740058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKIDMORE | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 24TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602932124 | ||||||||
| FaxNumber: | 3602930419 | ||||||||
| Practice Location | |||||||||
| Address1: | 1213 24TH ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602932124 | ||||||||
| FaxNumber: | 3602930419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00021142 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.