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General NPI Number Information
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NPI Number | 1902208705
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Entity Type | Individual
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Provider Name | KATHY LEE GUPTILL RPH
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 17100 STATE ROUTE 507 SE
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City | YELM
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State | WA
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Zip | 98597-7605
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Country | US
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Telephone | 360-400-8062
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Fax | 360-400-8065
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Provider Business Mailing Address
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Address Line | 17100 STATE ROUTE 507 SE
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City | YELM
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State | WA
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Zip | 98597-7605
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Country | US
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Telephone | 360-400-8062
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Fax | 360-400-8065
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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 | PH00040340
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2862
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26016529A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 009947
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S007979
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License Number State | AZ
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