=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679862189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUBLIC HOSPITAL DISTRICT 1 OF KING COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 S 43RD ST
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-5714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-917-6226
-----------------------------------------------------
Fax | 425-917-6248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 S 43RD ST
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98055-5714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-917-6226
-----------------------------------------------------
Fax | 425-917-6248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY,AO
-----------------------------------------------------
Name | KENNETH KENYON
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 425-228-3440
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number | PHAR.CF.60213405
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------