Provider Demographics
NPI:1275718348
Name:PHD#2 OF SNOHOMISH COUNTY
Entity Type:Organization
Organization Name:PHD#2 OF SNOHOMISH COUNTY
Other - Org Name:STEVENS HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPH
Authorized Official - Phone:425-640-4181
Mailing Address - Street 1:21601 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7507
Mailing Address - Country:US
Mailing Address - Phone:425-640-4180
Mailing Address - Fax:425-640-4182
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:425-640-4180
Practice Address - Fax:425-640-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHF00001038282N00000X, 333600000X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No282N00000XHospitalsGeneral Acute Care Hospital
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6004279Medicaid
4911853OtherNCPDP