Provider Demographics
NPI:1306976766
Name:MATSUZAKI, KATHLEEN K (RPH)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:K
Last Name:MATSUZAKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:K
Other - Last Name:MATSUZAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:20610 196TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-0549
Mailing Address - Country:US
Mailing Address - Phone:425-413-8846
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4612
Practice Address - Country:US
Practice Address - Phone:428-670-9987
Practice Address - Fax:425-744-7233
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist