Provider Demographics
NPI:1780134692
Name:KFKP OF THE NORTHWEST
Entity type:Organization
Organization Name:KFKP OF THE NORTHWEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ABERA
Authorized Official - Middle Name:GELETO
Authorized Official - Last Name:ABU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:360-907-9099
Mailing Address - Street 1:12607 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:360-907-9099
Mailing Address - Fax:360-882-3888
Practice Address - Street 1:2611 SE 130TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6583
Practice Address - Country:US
Practice Address - Phone:360-907-9099
Practice Address - Fax:360-882-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization