Healthcare Provider Details

I. General information

NPI: 1760427405
Provider Name (Legal Business Name): KAM L CAPOCCIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE BOX 354770
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

22910 83RD PL W
EDMONDS WA
98026-8423
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-5718
  • Fax: 206-598-5720
Mailing address:
  • Phone: 206-478-0991
  • Fax: 206-543-3835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH00042681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: