Provider Demographics
NPI:1154458586
Name:WARTER, KEN J (RPH)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:J
Last Name:WARTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13113 POINT RICHMOND BEACH RD NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-9658
Mailing Address - Country:US
Mailing Address - Phone:253-851-8575
Mailing Address - Fax:
Practice Address - Street 1:4818 POINT FOSDICK DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1711
Practice Address - Country:US
Practice Address - Phone:253-851-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist