Basic Information
Provider Information
NPI: 1558498782
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: KATHRYN
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential: PH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 34584
Address2:  
City: SEATTLE
State: WA
PostalCode: 981241584
CountryCode: US
TelephoneNumber: 5092417349
FaxNumber: 5092417268
Practice Location
Address1: 12401 E MARGINAL WAY S
Address2:  
City: TUKWILA
State: WA
PostalCode: 981682558
CountryCode: US
TelephoneNumber: 2069014422
FaxNumber: 2069014410
Other Information
ProviderEnumerationDate: 02/27/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XPH00013763WAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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