MEDICARE: NEIGHBORCARE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1689982225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORCARE HEALTH

Provider Business Mailing Address
First Line	:	905 SPRUCE ST
Second Line	:	STE 300
City	:	SEATTLE
State	:	WA
Zip	:	98104-2474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 N 41ST ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8212
Country	:	US
Telephone Number	:	206-940-2582
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARK SECORD
Credential	:
Telephone Number	:	206-548-3050

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	09/16/2010

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Directions to “NEIGHBORCARE HEALTH ” Practice Location

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