Provider Demographics
NPI:1750647707
Name:HARBORVIEW MEDICAL CENTER
Entity Type:Organization
Organization Name:HARBORVIEW MEDICAL CENTER
Other - Org Name:HARBORVIEW NINTH AND JEFFERSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIJALKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-744-3377
Mailing Address - Street 1:1959 NE PACIFIC ST # 356015
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-6059
Mailing Address - Fax:206-598-6075
Practice Address - Street 1:908 JEFFERSON ST # 359912
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2433
Practice Address - Country:US
Practice Address - Phone:206-744-3219
Practice Address - Fax:206-744-4201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBORVIEW MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X, 3336C0003X
WAPHARCF604210083336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134359OtherPK
WA4934433OtherNCPDP
WA2168473Medicaid