Provider Demographics
NPI:1518013887
Name:RUBENSTEIN MEMORIAL HLTH CTR PHARMACY
Entity Type:Organization
Organization Name:RUBENSTEIN MEMORIAL HLTH CTR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-543-5215
Mailing Address - Street 1:106 HALL HEALTH
Mailing Address - Street 2:MS BOX 354410
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-685-1021
Mailing Address - Fax:206-685-9990
Practice Address - Street 1:106 HALL HEALTH
Practice Address - Street 2:MS BOX 354410
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-685-1021
Practice Address - Fax:206-685-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFO 00000359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6131502Medicaid