Provider Demographics
NPI:1013512631
Name:MISHUROV, KATHLEEN MARGARET (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:MISHUROV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARGARET
Other - Last Name:HEALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:24106 185TH LOOP SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4897
Mailing Address - Country:US
Mailing Address - Phone:425-478-1248
Mailing Address - Fax:
Practice Address - Street 1:15615 BEL RED RD STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2300
Practice Address - Country:US
Practice Address - Phone:425-881-0222
Practice Address - Fax:425-885-1213
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60753576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist