Provider Demographics
NPI:1518961051
Name:SWEDISH EDMONDS
Entity Type:Organization
Organization Name:SWEDISH EDMONDS
Other - Org Name:PAVILION HOMECARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESPONSIBLE MANAGER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:425-673-3701
Mailing Address - Street 1:7320 216TH ST SW
Mailing Address - Street 2:STE 100B
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3720
Mailing Address - Fax:425-673-3727
Practice Address - Street 1:7320 216TH ST SW
Practice Address - Street 2:STE 100B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-673-3720
Practice Address - Fax:425-673-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF601829383336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6030910Medicaid
4932530OtherNCPDP PROVIDER IDENTIFICATION NUMBER