Healthcare Provider Details

I. General information

NPI: 1073281119
Provider Name (Legal Business Name): JESSICA MARIE MCKINNEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 DELRIDGE WAY SW STE 400
SEATTLE WA
98106-1273
US

IV. Provider business mailing address

6421 132ND AVE NE
KIRKLAND WA
98033-8600
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2626
  • Fax:
Mailing address:
  • Phone: 425-830-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61197022
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: