Healthcare Provider Details

I. General information

NPI: 1275718348
Provider Name (Legal Business Name): PHD#2 OF SNOHOMISH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

IV. Provider business mailing address

21601 76TH AVE W
EDMONDS WA
98026-7507
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-4180
  • Fax: 425-640-4182
Mailing address:
  • Phone: 425-640-4180
  • Fax: 425-640-4182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHF00001038
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHF00001038
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHF00001038
License Number StateWA

VIII. Authorized Official

Name: VALORIE J WILKINS
Title or Position: DIRECTOR OF PHARMACY
Credential: M.S., R.PH.
Phone: 425-640-4181