Provider Demographics
NPI:1255615191
Name:ECKHART, KAY LOUISE (RPH)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:LOUISE
Last Name:ECKHART
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 1:16514 SE 35TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9441
Mailing Address - Country:US
Mailing Address - Phone:360-256-2611
Mailing Address - Fax:
Practice Address - Street 1:1900 NE 162ND AVE BLDG C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3014
Practice Address - Country:US
Practice Address - Phone:360-891-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist