Provider Demographics
NPI:1043293806
Name:MCCULLOUGH, KRISTI SUE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:SUE
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14134 PHINNEY AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6847
Mailing Address - Country:US
Mailing Address - Phone:206-368-2535
Mailing Address - Fax:
Practice Address - Street 1:5605 22ND AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3119
Practice Address - Country:US
Practice Address - Phone:206-783-3051
Practice Address - Fax:206-784-9272
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00021654183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician