Provider Demographics
NPI:1760063184
Name:KEKELIA, NATIA
Entity Type:Individual
Prefix:
First Name:NATIA
Middle Name:
Last Name:KEKELIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 130TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9607
Mailing Address - Country:US
Mailing Address - Phone:206-939-1028
Mailing Address - Fax:
Practice Address - Street 1:4716 130TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9607
Practice Address - Country:US
Practice Address - Phone:206-939-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician