MEDICARE: MR. ROBERT CHARLES KITTAMS 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	PH00019483	WA

General Provider Information

NPI Number	:	1790851228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CHARLES KITTAMS RPH.

Provider Business Mailing Address
First Line	:	3520 S MOUNT VERNON ST
Second Line	:	UNIT 5
City	:	SPOKANE
State	:	WA
Zip	:	99223-4697
Country	:	US
Telephone Number	:	509-532-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 S SALNAVE ROAD
Second Line	:	LAKELAND VILLAGE PHARMACY DEPT.
City	:	MEDICAL LAKE
State	:	WA
Zip	:	99022-0200
Country	:	US
Telephone Number	:	509-299-1976
Fax Number	:	509-299-1967

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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