Healthcare Provider Details

I. General information

NPI: 1760787097
Provider Name (Legal Business Name): DEPARTMENT OF SOCIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 STELLACOOM BLVD SW
TACOMA WA
98498
US

IV. Provider business mailing address

9601 STEILACOOM BLVD SW
TACOMA WA
98498
US

V. Phone/Fax

Practice location:
  • Phone: 253-756-2521
  • Fax: 253-756-2707
Mailing address:
  • Phone: 253-756-2521
  • Fax: 253-756-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SKINNER
Title or Position: PHYSICIAN CREDENTIAL MANAGER
Credential:
Phone: 253-756-3966