Provider Demographics
NPI:1679978415
Name:MILLER, KENNETH DEAN (CPHT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N 184TH CT
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4538
Mailing Address - Country:US
Mailing Address - Phone:206-291-3888
Mailing Address - Fax:
Practice Address - Street 1:1320 N 184TH CT
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4538
Practice Address - Country:US
Practice Address - Phone:206-291-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00021811183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician