Healthcare Provider Details

I. General information

NPI: 1619352911
Provider Name (Legal Business Name): KEVIN JAMES FLYNN PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE # 359885
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY PHARMACY AND NUTRITIONAL CARE
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-4359
  • Fax: 206-744-5997
Mailing address:
  • Phone: 206-764-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14589
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60643584
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH60643584
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: