Healthcare Provider Details

I. General information

NPI: 1619193570
Provider Name (Legal Business Name): TULALIP CLINICAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 34TH AVE NE SUITE A
TULALIP WA
98271-8085
US

IV. Provider business mailing address

8825 34TH AVE NE SUITE A
TULALIP WA
98271-8085
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-2660
  • Fax: 360-716-3660
Mailing address:
  • Phone: 360-716-2660
  • Fax: 360-716-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00055944
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberCF00055944
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00055944
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARGARET GOODMAN
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 360-716-2664