=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275693244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MULTICARE HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17700 SE 272ND ST STE 100
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-372-7220
-----------------------------------------------------
Fax | 253-372-7221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17700 SE 272ND ST STE 100
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-4951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-372-7220
-----------------------------------------------------
Fax | 253-372-7221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PROVIDER ENROLLMENT
-----------------------------------------------------
Name | KELLY WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-459-8009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHAR.CF.00004705
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------