Provider Demographics
NPI:1407840929
Name:KOVEN, KATHRYN MARIE LEWIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE LEWIS
Last Name:KOVEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2603 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-1639
Mailing Address - Country:US
Mailing Address - Phone:509-554-1862
Mailing Address - Fax:509-527-6137
Practice Address - Street 1:77 WAINWRIGHT DR
Practice Address - Street 2:JM WAINWRIGHT VAMC
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3975
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:509-527-6137
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC76361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7636OtherSTATE PHARMACY LICENSE