Provider Demographics
NPI:1316220668
Name:ANDERTON, KATHY MAY (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MAY
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2348
Mailing Address - Country:US
Mailing Address - Phone:425-303-2584
Mailing Address - Fax:425-258-6252
Practice Address - Street 1:1825 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2348
Practice Address - Country:US
Practice Address - Phone:425-303-2584
Practice Address - Fax:425-258-6252
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00019611183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician