Provider Demographics
NPI:1891248480
Name:MCMAHON, KEVIN MILLARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MILLARD
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3024
Mailing Address - Country:US
Mailing Address - Phone:206-242-2030
Mailing Address - Fax:206-242-2018
Practice Address - Street 1:117 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3024
Practice Address - Country:US
Practice Address - Phone:206-242-2030
Practice Address - Fax:206-242-2018
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60668798183500000X
PARP448646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist