Provider Demographics
NPI:1700434982
Name:KALLER, KARENDEEP KAUR
Entity Type:Individual
Prefix:
First Name:KARENDEEP
Middle Name:KAUR
Last Name:KALLER
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 1:4607 219TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3609
Mailing Address - Country:US
Mailing Address - Phone:206-446-0829
Mailing Address - Fax:
Practice Address - Street 1:18305 ALDERWOOD MALL PKWY
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3961
Practice Address - Country:US
Practice Address - Phone:206-446-0829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60961754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist