Healthcare Provider Details

I. General information

NPI: 1659944064
Provider Name (Legal Business Name): KATHRYN BOUGH PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 E SPRAGUE AVE
SPOKANE VALLEY WA
99206-5151
US

IV. Provider business mailing address

13313 E 4TH AVE APT B208
SPOKANE VALLEY WA
99216-0683
US

V. Phone/Fax

Practice location:
  • Phone: 509-492-4922
  • Fax:
Mailing address:
  • Phone: 208-964-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA61059522
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: