MEDICARE: DR. THOMAS MILLAR KILLEN 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	PH00011114	WA

General Provider Information

NPI Number	:	1578695953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MILLAR KILLEN PHARMD

Provider Business Mailing Address
First Line	:	8102 58TH ST W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98467-3991
Country	:	US
Telephone Number	:	253-564-2255
Fax Number	:	253-564-0189

Provider Business Practice Location Address
First Line	:	3840 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4416
Country	:	US
Telephone Number	:	253-564-2255
Fax Number	:	253-564-0189

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

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	07/08/2007

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