Provider Demographics
NPI:1710083209
Name:PUGET SOUND DRUG CORPORATION
Entity Type:Organization
Organization Name:PUGET SOUND DRUG CORPORATION
Other - Org Name:KEY PHARMACY AND HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRISTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-878-3900
Mailing Address - Street 1:23422 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2718
Mailing Address - Country:US
Mailing Address - Phone:206-878-3900
Mailing Address - Fax:206-878-1114
Practice Address - Street 1:23422 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2718
Practice Address - Country:US
Practice Address - Phone:206-878-3900
Practice Address - Fax:206-878-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9016130Medicaid
WA11075OtherWA STATE L&I
WA9030644Medicaid
WA9035387Medicaid
WAKE0381OtherREGENCE RIDER
WAKE0381OtherREGENCE RIDER