Provider Demographics
NPI:1912221631
Name:WALGREENS 3840
Entity Type:Organization
Organization Name:WALGREENS 3840
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMD
Authorized Official - Prefix:
Authorized Official - First Name:HUDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-901-1816
Mailing Address - Street 1:14656 AMBAUM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-901-1816
Mailing Address - Fax:
Practice Address - Street 1:14656 AMBAUM BLVD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-901-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREEN.CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000488061835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty