Individual provider Active NPI

Jill Susanne Fraley, R.PH.

  • Pharmacist
  • Everett, WA
National Provider Identifier
1417258542
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH 00010307 Issued in WA
Practice address
7601 Evergreen Way Ste A1
Everett, WA 98203-6433
Phone
(425) 355-9303
Fax
(425) 355-9304
NPI assigned
Nov 5, 2010
Last updated
Dec 1, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH 00010307 WA Primary

Addresses

Primary practice location

7601 Evergreen Way Ste A1
Everett, WA 98203-6433

Mailing address

7601 Evergreen Way Ste A1
Everett, WA 98203-6433
Phone (425) 355-9303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PH 00010307WAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291161600000",
    "number": "1417258542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 EVERGREEN WAY STE A1",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036433",
            "telephone_number": "425-355-9303",
            "fax_number": "425-355-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 EVERGREEN WAY STE A1",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982036433",
            "telephone_number": "425-355-9303",
            "fax_number": "425-355-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRALEY",
        "first_name": "JILL",
        "middle_name": "SUSANNE",
        "credential": "R.PH.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-05",
        "last_updated": "2010-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH 00010307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.