Provider Demographics
NPI:1376164962
Name:TULALIP CLINICAL PHARMACY
Entity Type:Organization
Organization Name:TULALIP CLINICAL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:360-716-2660
Mailing Address - Street 1:8825 34TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:QUIL CEDA VILLAGE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8085
Mailing Address - Country:US
Mailing Address - Phone:357-716-4000
Mailing Address - Fax:360-716-3660
Practice Address - Street 1:8825 34TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:QUIL CEDA VILLAGE
Practice Address - State:WA
Practice Address - Zip Code:98271-8085
Practice Address - Country:US
Practice Address - Phone:357-716-4000
Practice Address - Fax:360-716-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULALIP CLINICAL PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty