Provider Demographics
NPI:1184965451
Name:KEDO, MARYNA V (RPH)
Entity type:Individual
Prefix:
First Name:MARYNA
Middle Name:V
Last Name:KEDO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12739 NE 133RD PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5409
Mailing Address - Country:US
Mailing Address - Phone:425-877-8487
Mailing Address - Fax:
Practice Address - Street 1:12739 NE 133RD PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5409
Practice Address - Country:US
Practice Address - Phone:425-877-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60267739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist