Provider Demographics
NPI:1316920176
Name:KURTENBACH, SHELLY (RPH)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:
Last Name:KURTENBACH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 142ND AVE NE
Mailing Address - Street 2:UNIT 4B
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:206-343-4870
Mailing Address - Fax:206-343-4884
Practice Address - Street 1:18800 142ND AVE NE
Practice Address - Street 2:UNIT 4B
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-455-2123
Practice Address - Fax:844-965-9828
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP19857183500000X
WAPH00019857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist