MEDICARE: WSM BELVEDERE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	CF.60273364	WA

General Provider Information

NPI Number	:	1821332347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WSM BELVEDERE INC

Provider Business Mailing Address
First Line	:	8830 ROOSEVELT WAY NE
Second Line	:	SUITE B
City	:	SEATTLE
State	:	WA
Zip	:	98115
Country	:	US
Telephone Number	:	206-402-3078
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 ROOSEVELT WAY NE
Second Line	:	SUITE B
City	:	SEATTLE
State	:	WA
Zip	:	98115-3042
Country	:	US
Telephone Number	:	206-402-3078
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM HERBERT MCNARY III
Credential	:	RPH
Telephone Number	:	206-402-3078

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	11/21/2012

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