1447312384 NPI number — MS. SUSAN MARGARET KALLAL MD PHARM D

Table of content: MS. SUSAN MARGARET KALLAL MD PHARM D (NPI 1447312384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447312384 NPI number — MS. SUSAN MARGARET KALLAL MD PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALLAL
Provider First Name:
SUSAN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447312384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 CORDATA PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98226-8059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-255-5049
Provider Business Mailing Address Fax Number:
360-778-2395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 CORDATA PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-8059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-255-5049
Provider Business Practice Location Address Fax Number:
360-778-2395
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  60450667 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: A70271 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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