MEDICARE: MEAGAN KAMMENGA PHARMD

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	PH00065066	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH00065066	OTHER	WA	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1568651057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN KAMMENGA PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-0307
Country	:	US
Telephone Number	:	360-966-3481
Fax Number	:	360-966-3083

Provider Business Practice Location Address
First Line	:	208 E MAIN ST
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-9126
Country	:	US
Telephone Number	:	360-966-3481
Fax Number	:	360-966-3083

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

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	08/08/2025

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Directions to “ MEAGAN KAMMENGA PHARMD” Practice Location

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