MEDICARE: KEN J WARTER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00009503	WA

General Provider Information

NPI Number	:	1154458586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEN J WARTER RPH

Provider Business Mailing Address
First Line	:	13113 POINT RICHMOND BEACH RD NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-9658
Country	:	US
Telephone Number	:	253-851-8575
Fax Number	:

Provider Business Practice Location Address
First Line	:	4818 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1711
Country	:	US
Telephone Number	:	253-851-6939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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