=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639870405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY IRENE SOWERS PHARMACY TECHNICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20330 BALLINGER WAY NE
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98155-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-368-0034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20330 BALLINGER WAY NE
-----------------------------------------------------
City | SHORELINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98155-1146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-368-0034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | VA61287952
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------