Healthcare Provider Details

I. General information

NPI: 1306365184
Provider Name (Legal Business Name): MADRONA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 CORSON AVE S STE C-1
SEATTLE WA
98108-2605
US

IV. Provider business mailing address

5959 CORSON AVE S STE C-1
SEATTLE WA
98108-2605
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-3300
  • Fax: 206-341-3329
Mailing address:
  • Phone: 206-341-3300
  • Fax: 206-341-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF60796655
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number132192
License Number StateAK

VIII. Authorized Official

Name: HUNG VAN TRUONG
Title or Position: EXECUTIVE DIRECTOR
Credential: PHARMD, MBA
Phone: 206-341-3300