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General NPI Number Information
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NPI Number | 1346854585
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Entity Type | Individual
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Provider Name | KENNEDY MARIE ERICKSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 422 S MARKET BLVD
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City | CHEHALIS
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State | WA
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Zip | 98532-3044
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Country | US
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Telephone | 360-262-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 210 W CHERRY ST
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City | CENTRALIA
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State | WA
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Zip | 98531-2568
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Country | US
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Telephone | 360-561-6773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH61448116
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PH61448116
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License Number State | WA
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