Provider Demographics
NPI:1568478295
Name:MULTICARE HEALTH SYSTEM
Entity Type:Organization
Organization Name:MULTICARE HEALTH SYSTEM
Other - Org Name:MULTICARE CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, AMBULATORY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HARBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:253-426-6209
Mailing Address - Street 1:521 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4238
Mailing Address - Country:US
Mailing Address - Phone:253-403-4920
Mailing Address - Fax:253-403-4856
Practice Address - Street 1:521 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4238
Practice Address - Country:US
Practice Address - Phone:253-403-4920
Practice Address - Fax:253-403-4856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MULTICARE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336I0012X
WAPHAR.CF.000052853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1044756Medicaid
2110269OtherPK
WA6016539Medicaid