Healthcare Provider Details

I. General information

NPI: 1912287731
Provider Name (Legal Business Name): MULTICARE HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 204TH AVE E SUITE 1200
BONNEY LAKE WA
98391-6539
US

IV. Provider business mailing address

10004 204TH AVE E SUITE 1200
BONNEY LAKE WA
98391-6539
US

V. Phone/Fax

Practice location:
  • Phone: 253-447-3355
  • Fax: 253-447-3375
Mailing address:
  • Phone: 253-447-3355
  • Fax: 253-447-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHARCF60229221
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERESA DIANE HARBERG
Title or Position: DIRECTOR, AMBULATORY PHARMACY
Credential: PHARMD
Phone: 253-426-6209