Provider Demographics
NPI:1093802290
Name:MULTICARE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MULTICARE HEALTH SYSTEMS
Other - Org Name:ALLENMORE MULTICARE CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, AMBULATORY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HARBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:253-426-6209
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:MS: 19U-1-ORX
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1702
Mailing Address - Country:US
Mailing Address - Phone:253-459-6746
Mailing Address - Fax:253-459-6251
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-459-6746
Practice Address - Fax:253-459-6251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-07
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
WAPHAR.CF.607589113336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110550OtherPK
WA1042840Medicaid
2110550OtherPK