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NPI Code Detail

MEDICARE: WASHINGTON STATE DEPT. OF SOCIAL & HEALTH SERVICES

MEDICARE: WASHINGTON STATE DEPT. OF SOCIAL & HEALTH SERVICES
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
1333600000XPharmacyFL00001190WA
23336L0003XLong Term Care Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14931665OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1821030123
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASHINGTON STATE DEPT. OF SOCIAL & HEALTH SERVICES
Provider Business Mailing Address
First Line : 609 SPEYERS RD
Second Line :
City : SELAH
State : WA
Zip : 98942-1050
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 609 SPEYERS RD
Second Line :
City : SELAH
State : WA
Zip : 98942-1050
Country : US
Telephone Number : 509-698-1345
Fax Number : 509-697-2217
Authorized Official
Title or Position : PHARMACIST
Name : MR. DAVID L. CHRISTENSEN
Credential : RPH
Telephone Number : 509-698-1345
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/29/2008

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Directions to “WASHINGTON STATE DEPT. OF SOCIAL & HEALTH SERVICES ” Practice Location

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