1922080233 NPI number — I V PHARMACY

Table of content: (NPI 1922080233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922080233 NPI number — I V PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I V PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922080233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98464-0154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-581-7660
Provider Business Mailing Address Fax Number:
253-565-2967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5515 STEILACOOM BLVD SW
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-7660
Provider Business Practice Location Address Fax Number:
253-565-2967
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATTEN
Authorized Official First Name:
HEE-WON
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
253-581-7660

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  PF00002516 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 333600000X , with the licence number: PF00002516 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6000970 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com