Provider Demographics
NPI:1114938610
Name:MALCOM T MORRIS
Entity Type:Organization
Organization Name:MALCOM T MORRIS
Other - Org Name:WHITE CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-763-2500
Mailing Address - Street 1:9601 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2828
Mailing Address - Country:US
Mailing Address - Phone:206-763-2500
Mailing Address - Fax:206-762-4667
Practice Address - Street 1:9601 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2828
Practice Address - Country:US
Practice Address - Phone:206-763-2500
Practice Address - Fax:206-762-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000021293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4915546OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WA6135800Medicaid
WA6135800Medicaid