Healthcare Provider Details

I. General information

NPI: 1619090487
Provider Name (Legal Business Name): KENNEWICK GENERAL HOSITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N YOUNG ST
KENNEWICK WA
99336-7806
US

IV. Provider business mailing address

3730 PLAZA WAY
KENNEWICK WA
99338-2718
US

V. Phone/Fax

Practice location:
  • Phone: 509-221-6150
  • Fax: 509-221-6151
Mailing address:
  • Phone: 509-221-6150
  • Fax: 509-221-6151

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 NumberCF000056883
License Number StateWA

VIII. Authorized Official

Name: MICHAEL PORTER
Title or Position: PHCY MANAGER
Credential:
Phone: 509-221-7351