Healthcare Provider Details

I. General information

NPI: 1568030773
Provider Name (Legal Business Name): CONNOR KAMM SMITH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11019 CANYON RD E
PUYALLUP WA
98373-3001
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-1180
  • Fax: 425-595-2950
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH61187298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: