Healthcare Provider Details

I. General information

NPI: 1619353083
Provider Name (Legal Business Name): KATHLEEN BREANNE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S 120TH PL STE 100
TUKWILA WA
98168-5134
US

IV. Provider business mailing address

3333 S 120TH PL STE 100
TUKWILA WA
98168-5134
US

V. Phone/Fax

Practice location:
  • Phone: 425-687-4454
  • Fax: 425-687-4401
Mailing address:
  • Phone: 425-687-4454
  • Fax: 425-687-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60562091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: