Provider Demographics
NPI:1316365299
Name:FRANCISCAN COMPOUNDING PHARMACY ST CLARE
Entity Type:Organization
Organization Name:FRANCISCAN COMPOUNDING PHARMACY ST CLARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:253-426-6209
Mailing Address - Street 1:11315 BRIDGEPORT WAY SW STE A1087
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3004
Mailing Address - Country:US
Mailing Address - Phone:253-985-6290
Mailing Address - Fax:253-985-6295
Practice Address - Street 1:11315 BRIDGEPORT WAY SW STE A1087
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-985-6290
Practice Address - Fax:253-985-6295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.601654163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4924432OtherNCDPD