Healthcare Provider Details

I. General information

NPI: 1134058043
Provider Name (Legal Business Name): KA SON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEN SON

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 3RD AVE SE STE 200
LACEY WA
98503-1010
US

IV. Provider business mailing address

4525 3RD AVE SE STE 200
LACEY WA
98503-1010
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-3934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPHRM.PH.61449724
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: