Provider Demographics
NPI:1275693244
Name:MULTICARE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MULTICARE HEALTH SYSTEMS
Other - Org Name:COVINGTON MULTICARE CLINIC
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:PHARM D
Authorized Official - Phone:253-426-2283
Mailing Address - Street 1:17700 SE 272ND ST
Mailing Address - Street 2:STE 100
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4951
Mailing Address - Country:US
Mailing Address - Phone:253-372-7220
Mailing Address - Fax:253-372-7221
Practice Address - Street 1:17700 SE 272ND ST
Practice Address - Street 2:STE 100
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4951
Practice Address - Country:US
Practice Address - Phone:253-372-7220
Practice Address - Fax:253-372-7221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.000047053336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043545Medicaid
2109526OtherPK
WA6014641Medicaid