Provider Demographics
NPI:1598731051
Name:PUBLIC HOSPITAL DISTRICT NO 2 OF KING COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT NO 2 OF KING COUNTY
Other - Org Name:PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLITOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-899-2808
Mailing Address - Street 1:11800 NE 128TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 NE 128TH ST
Practice Address - Street 2:STE 150
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7208
Practice Address - Country:US
Practice Address - Phone:425-899-2808
Practice Address - Fax:425-899-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF584503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028971Medicaid
4931754OtherNCPDP PROVIDER IDENTIFICATION NUMBER