Provider Demographics
NPI:1598832412
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:EVERGREEN PROFESSIONAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-899-2794
Mailing Address - Street 1:12303 NE 130TH LN
Mailing Address - Street 2:STE 210
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3099
Mailing Address - Country:US
Mailing Address - Phone:425-899-2790
Mailing Address - Fax:425-899-2795
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:STE 210
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-899-2790
Practice Address - Fax:425-899-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHARCF000048333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109598OtherPK
WA6013734Medicaid