Healthcare Provider Details

I. General information

NPI: 1578695953
Provider Name (Legal Business Name): THOMAS MILLAR KILLEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4416
US

IV. Provider business mailing address

8102 58TH ST W
UNIVERSITY PLACE WA
98467-3991
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-2255
  • Fax: 253-564-0189
Mailing address:
  • Phone: 253-564-2255
  • Fax: 253-564-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: