Healthcare Provider Details

I. General information

NPI: 1619527595
Provider Name (Legal Business Name): KATHERINE DOREEN CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE DOREEN HAWKINSON

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE C-WING FIRST FLOOR
EVERETT WA
98201
US

IV. Provider business mailing address

1321 COLBY AVE
EVERETT WA
98201-1665
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-3559
  • Fax: 425-261-3560
Mailing address:
  • Phone: 425-261-3559
  • Fax: 425-261-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00021175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: