Healthcare Provider Details

I. General information

NPI: 1427105030
Provider Name (Legal Business Name): WASHINGTON STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON STREET
PULLMAN WA
99163
US

IV. Provider business mailing address

PO BOX 642302 1125 SE WASHINGTON STREET
PULLMAN WA
99164-2302
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-5742
  • Fax: 509-335-5745
Mailing address:
  • Phone: 509-335-5742
  • Fax: 509-335-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCF0056228
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6012942
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier4926537
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerNABP

VIII. Authorized Official

Name: RENEE L HEIMBIGNER
Title or Position: PHARMACY MANAGER
Credential: PHARMACIST
Phone: 509-335-5742