Provider Demographics
NPI:1306365184
Name:MADRONA HEALTH, LLC
Entity Type:Organization
Organization Name:MADRONA HEALTH, LLC
Other - Org Name:MADRONA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:206-341-3300
Mailing Address - Street 1:5959 CORSON AVE S STE C-1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2605
Mailing Address - Country:US
Mailing Address - Phone:206-341-3300
Mailing Address - Fax:206-341-3329
Practice Address - Street 1:5959 CORSON AVE S STE C-1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2605
Practice Address - Country:US
Practice Address - Phone:206-341-3300
Practice Address - Fax:206-341-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF60796655333600000X
AK1321923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2171441OtherPK