Provider Demographics
NPI:1528247194
Name:HENNESSEY, COLLIN K (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:K
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 E MARGINAL WAY S
Mailing Address - Street 2:GROUP HEALTH PHARMACY ADMIN
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2559
Mailing Address - Country:US
Mailing Address - Phone:206-901-4321
Mailing Address - Fax:206-901-4410
Practice Address - Street 1:12400 E MARGINAL WAY S
Practice Address - Street 2:GROUP HEALTH PHARMACY ADMIN
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2559
Practice Address - Country:US
Practice Address - Phone:206-901-4321
Practice Address - Fax:206-901-4410
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist