1497030712 NPI number — DR. CORY MICHAEL KANTOROWICZ PHARMD

Table of content: ROBERT HENRY BOREN (NPI 1548142466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497030712 NPI number — DR. CORY MICHAEL KANTOROWICZ PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTOROWICZ
Provider First Name:
CORY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

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:
1497030712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 POWELL AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-277-1311
Provider Business Mailing Address Fax Number:
425-277-1566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 E MEEKER ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98030-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-233-0246
Provider Business Practice Location Address Fax Number:
253-372-3663
Provider Enumeration Date:
10/18/2011

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: 183500000X , with the licence number:  RPH-0012781 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: PH 60244426 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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