Provider Demographics
NPI:1548565393
Name:MULTICARE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MULTICARE HEALTH SYSTEMS
Other - Org Name:GOOD SAMARITAN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULATORY PHARMACY MANAGER
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:253-403-3687
Mailing Address - Street 1:325 E PIONEER
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3265
Mailing Address - Country:US
Mailing Address - Phone:253-697-8333
Mailing Address - Fax:253-770-7018
Practice Address - Street 1:325 E PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3265
Practice Address - Country:US
Practice Address - Phone:253-697-8333
Practice Address - Fax:253-770-7018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-25
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336C0003X
WA601995853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127663OtherPK
WA1548565393Medicaid