Provider Demographics
NPI:1588395263
Name:MILEY-BOWTHORPE, KARI ANN
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:ANN
Last Name:MILEY-BOWTHORPE
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 1:2203 AUGUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8304
Mailing Address - Country:US
Mailing Address - Phone:360-739-7858
Mailing Address - Fax:
Practice Address - Street 1:5655 3RD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8394
Practice Address - Country:US
Practice Address - Phone:360-384-1551
Practice Address - Fax:360-384-0642
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00040455183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician