Provider Demographics
NPI:1992097380
Name:KWON, LAURIE (BSCPHARM)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:BSCPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717A 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3117
Mailing Address - Country:US
Mailing Address - Phone:206-962-7045
Mailing Address - Fax:
Practice Address - Street 1:32015 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6001
Practice Address - Country:US
Practice Address - Phone:253-945-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist