Provider Demographics
NPI:1821218876
Name:COMMUNITY HEALTH CENTERS OF KING COUNTY
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF KING COUNTY
Other - Org Name:KENT COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROMPETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-277-1311
Mailing Address - Street 1:403 E MEEKER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5904
Mailing Address - Country:US
Mailing Address - Phone:253-372-3661
Mailing Address - Fax:253-372-3663
Practice Address - Street 1:955 POWELL AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2908
Practice Address - Country:US
Practice Address - Phone:425-277-1311
Practice Address - Fax:425-277-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000590253336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4932314OtherNATIONAL ASSOC BOARD OF P