=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871736702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANCISCAN HEALTH SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2009
-----------------------------------------------------
Last Update Date | 03/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11511 CANTERWOOD BLVD NW STE 220
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98332-5813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-530-2066
-----------------------------------------------------
Fax | 253-530-2625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 31001-1489
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91110-1489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-530-2653
-----------------------------------------------------
Fax | 253-530-2625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULATORY PHARMACY MANAGER
-----------------------------------------------------
Name | TERESA HARBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-426-6209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHARCF60078630
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------