Provider Demographics
NPI:1912274119
Name:PARKINSON, KATHLEEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PARKINSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14515 LINDSAY LOOP SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8598
Mailing Address - Country:US
Mailing Address - Phone:208-409-6049
Mailing Address - Fax:
Practice Address - Street 1:4540 LACEY BLVD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5719
Practice Address - Country:US
Practice Address - Phone:360-435-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH61162305OtherWASHINGTON DEPARTMENT OF HEALTH
MTPHA-PHA-LIC-62964OtherMONTANA STATE BOARD OF PHARMACY
IDP5910OtherIDAHO STATE BOARD OF PHARMACY