Provider Demographics
NPI:1114113602
Name:SEA MAR COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:SEA MAR COMMUNITY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-704-7575
Mailing Address - Street 1:3030 LIMITED LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2704
Mailing Address - Country:US
Mailing Address - Phone:360-704-7575
Mailing Address - Fax:360-704-7579
Practice Address - Street 1:3030 LIMITED LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2704
Practice Address - Country:US
Practice Address - Phone:360-704-7575
Practice Address - Fax:360-704-7579
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEA MAR COMMUNITY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF590393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy