Basic Information
| Provider Information | |||||||||
| NPI: | 1891248480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMAHON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MILLARD | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 SW 160TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062422030 | ||||||||
| FaxNumber: | 2062422018 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 SW 160TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062422030 | ||||||||
| FaxNumber: | 2062422018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2016 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60668798 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | RP448646 | PA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.