Healthcare Provider Details

I. General information

NPI: 1164472171
Provider Name (Legal Business Name): NORTHWEST HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S DIVISION ST
SPOKANE WA
99202-1510
US

IV. Provider business mailing address

2818 N SULLIVAN RD BLDG 2E
SPOKANE VALLEY WA
99216-5074
US

V. Phone/Fax

Practice location:
  • Phone: 509-742-3492
  • Fax: 509-742-3494
Mailing address:
  • Phone: 509-742-3492
  • Fax: 509-742-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberCF00058494
License Number StateWA

VIII. Authorized Official

Name: KEVIN KING
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 509-742-3492