Provider Demographics
NPI:1588014443
Name:MAXWELL, KATIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3468
Mailing Address - Country:US
Mailing Address - Phone:360-825-5739
Mailing Address - Fax:
Practice Address - Street 1:1350 GARRETT ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3468
Practice Address - Country:US
Practice Address - Phone:360-825-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60667237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist