Provider Demographics
NPI:1174846323
Name:KILLORAN, AMY
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:KILLORAN
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 1:6797 ST HWY 303 NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3736
Mailing Address - Country:US
Mailing Address - Phone:360-698-3446
Mailing Address - Fax:360-698-1326
Practice Address - Street 1:6797 ST HWY 303 NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3736
Practice Address - Country:US
Practice Address - Phone:360-698-3446
Practice Address - Fax:360-698-1326
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507791183500000X
WAPH60586422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist