Provider Demographics
NPI:1538414172
Name:KIDD, BETSY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4932
Mailing Address - Country:US
Mailing Address - Phone:775-336-8371
Mailing Address - Fax:
Practice Address - Street 1:9709 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9445
Practice Address - Country:US
Practice Address - Phone:775-336-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60278534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60278534OtherWASHINGTON STATE LICENSE NUMBER