Healthcare Provider Details

I. General information

NPI: 1003073818
Provider Name (Legal Business Name): KATHLEEN LOUISE COCKRILL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11521 NE 128TH ST STE 100 EVERGREEN SENIOR HEALTH SPECIALISTS
KIRKKLAND WA
98034-3098
US

IV. Provider business mailing address

11521 NE 128TH ST STE 100 EVERGREEN SENIOR HEALTH SPECIALISTS
KIRKKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-6800
  • Fax: 425-899-6806
Mailing address:
  • Phone: 425-899-6800
  • Fax: 425-899-6806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPH00010653
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00010653
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: