Provider Demographics
NPI:1003073818
Name:COCKRILL, KATHLEEN LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:COCKRILL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11521 NE 128TH ST STE 100
Mailing Address - Street 2:EVERGREEN SENIOR HEALTH SPECIALISTS
Mailing Address - City:KIRKKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-6800
Mailing Address - Fax:425-899-6806
Practice Address - Street 1:11521 NE 128TH ST STE 100
Practice Address - Street 2:EVERGREEN SENIOR HEALTH SPECIALISTS
Practice Address - City:KIRKKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3098
Practice Address - Country:US
Practice Address - Phone:425-899-6800
Practice Address - Fax:425-899-6806
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPH000106531835G0303X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy