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General NPI Number Information
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NPI Number | 1093123184
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Entity Type | Organization
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Legal Business Name | PPGNW - ID PHARMACY
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 2001 E MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98122-2959
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Country | US
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Telephone | 206-328-7734
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 E MADISON ST
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City | SEATTLE
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State | WA
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Zip | 98122-2959
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Country | US
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Telephone | 206-328-7734
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE DIRECTOR
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Name | MARY WENDT
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Credential |
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Telephone | 206-628-3826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 19941PDO
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License Number State | ID
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