=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841520061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANCISCAN HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2010
-----------------------------------------------------
Last Update Date | 08/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15214 CANYON RD E SUITE 110
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-7472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-539-6030
-----------------------------------------------------
Fax | 253-539-6035
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15214 CANYON RD E SUITE 110
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-7472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-539-6030
-----------------------------------------------------
Fax | 253-539-6035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULATORY PHARMACY MANAGER
-----------------------------------------------------
Name | TERESA HARBERG
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 253-426-6209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | CF60115736
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------