Provider Demographics
NPI:1033753694
Name:PHILLIPS, KAILEY M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24499 E PINNACLE CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-4506
Mailing Address - Country:US
Mailing Address - Phone:509-842-4161
Mailing Address - Fax:
Practice Address - Street 1:1802 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4528
Practice Address - Country:US
Practice Address - Phone:509-343-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60789839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist