Provider Demographics
NPI:1619353083
Name:FLYNN, KATHLEEN BREANNE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:BREANNE
Last Name:FLYNN
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 1:3333 S 120TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5134
Mailing Address - Country:US
Mailing Address - Phone:425-687-4454
Mailing Address - Fax:425-687-4401
Practice Address - Street 1:3333 S 120TH PL STE 100
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5134
Practice Address - Country:US
Practice Address - Phone:425-687-4454
Practice Address - Fax:425-687-4401
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60562091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist