Provider Demographics
NPI:1346502044
Name:MAIN, KENNETH IAN (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:IAN
Last Name:MAIN
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 1:9999 HOLMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2041
Mailing Address - Country:US
Mailing Address - Phone:206-782-4100
Mailing Address - Fax:206-784-7196
Practice Address - Street 1:9999 HOLMAN RD NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2041
Practice Address - Country:US
Practice Address - Phone:206-782-4100
Practice Address - Fax:206-784-7196
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00009937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist