Provider Demographics
NPI:1831104454
Name:ETS CONSULTING LLC
Entity Type:Organization
Organization Name:ETS CONSULTING LLC
Other - Org Name:SHIRAZ SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-672-5809
Mailing Address - Street 1:24255 VAN RY BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5460
Mailing Address - Country:US
Mailing Address - Phone:425-356-3276
Mailing Address - Fax:425-356-3101
Practice Address - Street 1:24255 VAN RY BLVD STE A1
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5460
Practice Address - Country:US
Practice Address - Phone:425-356-3276
Practice Address - Fax:425-356-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WAPHARM.CF.606913353336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108647OtherPK
WA6028393Medicaid
WA6028393Medicaid