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NPI Code Detail

MEDICARE: KEITH J VANDERHOUWEN RPH

MEDICARE: KEITH J VANDERHOUWEN 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
1183500000XPharmacistPH00007576WA

General Provider Information

NPI Number : 1861433708
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH J VANDERHOUWEN RPH
Provider Business Mailing Address
First Line : 17323 TROMBLEY RD
Second Line :
City : SNOHOMISH
State : WA
Zip : 98290-6329
Country : US
Telephone Number : 360-568-1948
Fax Number :
Provider Business Practice Location Address
First Line : 17788 147TH ST SE
Second Line :
City : MONROE
State : WA
Zip : 98272-1030
Country : US
Telephone Number : 360-794-7351
Fax Number : 360-794-5751
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 07/08/2007

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Directions to “ KEITH J VANDERHOUWEN RPH” Practice Location

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