MEDICARE: KATHLEEN NUSBAUM PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	60657010	WA

General Provider Information

NPI Number	:	1528513371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN NUSBAUM PHARM D

Provider Business Mailing Address
First Line	:	2811 W 10TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-3104
Country	:	US
Telephone Number	:	509-735-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 W 10TH AVE
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-3104
Country	:	US
Telephone Number	:	509-735-8733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	05/13/2026

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