Healthcare Provider Details

I. General information

NPI: 1013950393
Provider Name (Legal Business Name): WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 15TH AVE NE
SHORELINE WA
98155-7130
US

IV. Provider business mailing address

15230 15TH AVE NE
SHORELINE WA
98155-7130
US

V. Phone/Fax

Practice location:
  • Phone: 206-361-3565
  • Fax: 206-361-3157
Mailing address:
  • Phone: 206-361-3565
  • Fax: 206-361-3157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberFL00000256
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberFL00000256
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberFL00000256
License Number StateWA

VIII. Authorized Official

Name: DR. ASHA SINGH
Title or Position: SUPERINTENDENT
Credential: MD
Phone: 206-361-3032