Healthcare Provider Details

I. General information

NPI: 1053799403
Provider Name (Legal Business Name): BLOODWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 TERRY AVE SUITE A
SEATTLE WA
98104-1239
US

IV. Provider business mailing address

921 TERRY AVE SUITE A
SEATTLE WA
98104-1239
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6500
  • Fax:
Mailing address:
  • Phone: 206-292-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHWH.FX.60073065
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60546394
License Number StateWA

VIII. Authorized Official

Name: MR. ROBERT J GLEASON
Title or Position: CFO
Credential:
Phone: 206-689-6680