Provider Demographics
NPI:1619552486
Name:HARBOR HEALTH, LLC
Entity Type:Organization
Organization Name:HARBOR HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:253-525-1362
Mailing Address - Street 1:3216 JUDSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1224
Mailing Address - Country:US
Mailing Address - Phone:253-525-1362
Mailing Address - Fax:253-525-1383
Practice Address - Street 1:3216 JUDSON ST STE A
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1224
Practice Address - Country:US
Practice Address - Phone:253-525-1362
Practice Address - Fax:253-525-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy