Provider Demographics
NPI:1578629085
Name:SULENES, KIRK EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EDWARD
Last Name:SULENES
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 1:3116 LANGRIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4449
Mailing Address - Country:US
Mailing Address - Phone:360-754-2073
Mailing Address - Fax:
Practice Address - Street 1:700 LILLY RD NE GROUP HEALTH CO-OP
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-923-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA009500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist