Healthcare Provider Details

I. General information

NPI: 1104969518
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S
RENTON WA
98055-5738
US

IV. Provider business mailing address

3915 TALBOT RD S
RENTON WA
98055-5738
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4050
  • Fax: 425-656-5036
Mailing address:
  • Phone: 425-656-4050
  • Fax: 425-656-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60213412
License Number StateWA

VIII. Authorized Official

Name: KEN KENYON
Title or Position: DIRECTOR OF PHARMACY SERVICES/AO
Credential: PHARMD
Phone: 425-228-3440