=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285173930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEATTLE CHILDREN'S HOSPITAL PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2017
-----------------------------------------------------
Last Update Date | 09/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 SAND POINT WAY NE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98105-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-987-2033
-----------------------------------------------------
Fax | 206-987-2597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5371 MB.5.420
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98145-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-987-2033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP, REVENUE CYCLE
-----------------------------------------------------
Name | SUZANNE VANDERWERFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-987-5778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | PHAR.CF.0000096
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------