Provider Demographics
NPI:1316213317
Name:PHAM, KIM K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:K
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4256
Mailing Address - Country:US
Mailing Address - Phone:425-379-7487
Mailing Address - Fax:425-379-7489
Practice Address - Street 1:10200 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4256
Practice Address - Country:US
Practice Address - Phone:425-379-7487
Practice Address - Fax:425-379-7489
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00019688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0700980018OtherPROVIDER ID#
WABC4997966OtherDEA#