Healthcare Provider Details

I. General information

NPI: 1235010794
Provider Name (Legal Business Name): KAYLA RAE HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 BASIN ST SW
EPHRATA WA
98823-2138
US

IV. Provider business mailing address

1150 BASIN ST SW
EPHRATA WA
98823-2138
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-4441
  • Fax:
Mailing address:
  • Phone: 509-754-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61690922
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: