Provider Demographics
NPI:1942596432
Name:KUA, REBECCA
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:
Last Name:KUA
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 1:27711 NE BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9601
Mailing Address - Country:US
Mailing Address - Phone:360-423-4833
Mailing Address - Fax:
Practice Address - Street 1:364 TRIANGLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4651
Practice Address - Country:US
Practice Address - Phone:360-423-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00059667183500000X
ORRPH0012080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist