Provider Demographics
NPI:1396005294
Name:MULTICARE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MULTICARE HEALTH SYSTEMS
Other - Org Name:MULTICARE WESTGATE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:253-447-3355
Mailing Address - Street 1:2209 N PEARL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2529
Mailing Address - Country:US
Mailing Address - Phone:253-447-3355
Mailing Address - Fax:253-447-3375
Practice Address - Street 1:2209 N PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2529
Practice Address - Country:US
Practice Address - Phone:253-459-7144
Practice Address - Fax:253-459-7143
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-24
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0004X, 3336C0004X, 3336S0011X
WAPHAR.CF.602836413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1396005294Medicaid
2135381OtherPK