Provider Demographics
NPI:1871893636
Name:KAIN, KELLY M (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:M
Last Name:KAIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4280 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5354
Mailing Address - Country:US
Mailing Address - Phone:360-456-0709
Mailing Address - Fax:360-459-9516
Practice Address - Street 1:4280 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5354
Practice Address - Country:US
Practice Address - Phone:360-456-0709
Practice Address - Fax:360-459-9516
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60096484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist