Healthcare Provider Details

I. General information

NPI: 1598454589
Provider Name (Legal Business Name): AEQUITA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12825 NE 126TH PL
KIRKLAND WA
98034-7721
US

IV. Provider business mailing address

12825 NE 126TH PL
KIRKLAND WA
98034-7721
US

V. Phone/Fax

Practice location:
  • Phone: 425-224-2330
  • Fax:
Mailing address:
  • Phone: 425-224-2330
  • Fax: 425-305-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHAN ROBERT KENNEY
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD, RPH
Phone: 425-224-2330