Healthcare Provider Details

I. General information

NPI: 1023678240
Provider Name (Legal Business Name): WASHINGTON INSTITUTE FOR COAGULATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PIKE ST STE 1900
SEATTLE WA
98101-3932
US

IV. Provider business mailing address

701 PIKE ST STE 1900
SEATTLE WA
98101-3932
US

V. Phone/Fax

Practice location:
  • Phone: 206-614-1200
  • Fax: 206-614-1700
Mailing address:
  • Phone: 206-614-1200
  • Fax: 206-614-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA KRUSE-JARRES
Title or Position: EXECUTIVE OFFICER
Credential: MD
Phone: 206-614-1200