Provider Demographics
NPI:1598837585
Name:WOODINVILLE PHARMACY INC
Entity Type:Organization
Organization Name:WOODINVILLE PHARMACY INC
Other - Org Name:WOODINVILLE MEDICAL CENTER PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHAMACIST CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FICKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-485-2900
Mailing Address - Street 1:17000 140TH AVE NE UNIT E101
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6903
Mailing Address - Country:US
Mailing Address - Phone:425-485-2900
Mailing Address - Fax:425-481-5064
Practice Address - Street 1:17000 140TH AVE NE UNIT E101
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6903
Practice Address - Country:US
Practice Address - Phone:425-485-2900
Practice Address - Fax:425-481-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4921222OtherNCPDP
WA6010334Medicaid
WA60467OtherSTATE LABOR AND INDUSTRIE