Healthcare Provider Details

I. General information

NPI: 1215296934
Provider Name (Legal Business Name): KRISTIN GAUTHIER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13023 GREENWOOD AVE N
SEATTLE WA
98133-7308
US

IV. Provider business mailing address

PO BOX 33026
SEATTLE WA
98133-0026
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-4048
  • Fax: 206-365-4096
Mailing address:
  • Phone: 206-365-4048
  • Fax: 206-365-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00051669
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: