Healthcare Provider Details

I. General information

NPI: 1427569730
Provider Name (Legal Business Name): KEELY JEAN HUTING PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 DELRIDGE WAY SW
SEATTLE WA
98106-1249
US

IV. Provider business mailing address

801 SPRING ST APT 2-603
SEATTLE WA
98104-1286
US

V. Phone/Fax

Practice location:
  • Phone: 319-290-9696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60762757
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: