Healthcare Provider Details

I. General information

NPI: 1831342609
Provider Name (Legal Business Name): KATHLEEN R HENRY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 S 255TH ST APT DD202
KENT WA
98032-4996
US

IV. Provider business mailing address

6216 S 255TH ST APT DD202
KENT WA
98032-4996
US

V. Phone/Fax

Practice location:
  • Phone: 253-670-8884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA 60041777
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: