Provider Demographics
NPI:1760787097
Name:DEPARTMENT OF SOCIAL
Entity Type:Organization
Organization Name:DEPARTMENT OF SOCIAL
Other - Org Name:WESTERN STATE HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN CREDENTIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-756-3966
Mailing Address - Street 1:9601 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98498
Mailing Address - Country:US
Mailing Address - Phone:253-756-2521
Mailing Address - Fax:253-756-2707
Practice Address - Street 1:9601 STELLACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98498
Practice Address - Country:US
Practice Address - Phone:253-756-2521
Practice Address - Fax:253-756-2707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN STATE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-18
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
504003Medicare UPIN