Healthcare Provider Details

I. General information

NPI: 1184989352
Provider Name (Legal Business Name): MICHELLE KIESZLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22303 MOUNTAIN HWY E
SPANAWAY WA
98387-7529
US

IV. Provider business mailing address

22303 MOUNTAIN HWY E
SPANAWAY WA
98387-7529
US

V. Phone/Fax

Practice location:
  • Phone: 253-875-4033
  • Fax:
Mailing address:
  • Phone: 253-875-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00060138
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: