Healthcare Provider Details

I. General information

NPI: 1558728527
Provider Name (Legal Business Name): KEVIN PATRICK WILLARD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 POINT FOSDICK DR NW SUITE 215
GIG HARBOR WA
98335-1700
US

IV. Provider business mailing address

4545 POINT FOSDICK DR NW SUITE 215
GIG HARBOR WA
98335-1700
US

V. Phone/Fax

Practice location:
  • Phone: 253-530-8068
  • Fax: 253-530-8069
Mailing address:
  • Phone: 253-530-8068
  • Fax: 253-530-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 00014987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: