Healthcare Provider Details

I. General information

NPI: 1679862189
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

400 S 43RD ST
RENTON WA
98055-5714
US

V. Phone/Fax

Practice location:
  • Phone: 425-917-6226
  • Fax: 425-917-6248
Mailing address:
  • Phone: 425-917-6226
  • Fax: 425-917-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHAR.CF.60213405
License Number StateWA

VIII. Authorized Official

Name: KENNETH KENYON
Title or Position: DIRECTOR OF PHARMACY,AO
Credential: PHARMD
Phone: 425-228-3440