Provider Demographics
NPI:1659944064
Name:BOUGH, KATHRYN (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BOUGH
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 E 4TH AVE APT B208
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0683
Mailing Address - Country:US
Mailing Address - Phone:208-964-1636
Mailing Address - Fax:
Practice Address - Street 1:12222 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5151
Practice Address - Country:US
Practice Address - Phone:509-492-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61059522183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician