Provider Demographics
NPI:1295401123
Name:MILLER, MARY KATHERINE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY KATHERINE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:128 STATE ST S APT 341
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6755
Mailing Address - Country:US
Mailing Address - Phone:513-439-2873
Mailing Address - Fax:
Practice Address - Street 1:128 STATE ST S APT 341
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6755
Practice Address - Country:US
Practice Address - Phone:513-439-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61173674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist