Provider Demographics
NPI:1093380925
Name:DEPLAZES, KATHRYN JEAN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:DEPLAZES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W WELLESLEY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5000
Mailing Address - Country:US
Mailing Address - Phone:509-328-7887
Mailing Address - Fax:
Practice Address - Street 1:2214A W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5002
Practice Address - Country:US
Practice Address - Phone:509-328-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60420645183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician