Provider Demographics
NPI:1568993368
Name:BERENSTEIN, KATHRYN ROSE MAHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE MAHAN
Last Name:BERENSTEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:MAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:#702
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 MADISON ST
Practice Address - Street 2:#702
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1172
Practice Address - Country:US
Practice Address - Phone:206-622-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60742401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist