Provider Demographics
NPI:1942333422
Name:INTERNATIONAL COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:INTERNATIONAL COMMUNITY HEALTH SERVICES
Other - Org Name:ID PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HERMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-788-3618
Mailing Address - Street 1:P.O. BOX 3007
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3007
Mailing Address - Country:US
Mailing Address - Phone:206-788-3770
Mailing Address - Fax:206-788-3705
Practice Address - Street 1:720 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98114-3007
Practice Address - Country:US
Practice Address - Phone:206-788-3770
Practice Address - Fax:206-788-3705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL COMMUNITY HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 3336L0003X
WACF000560683336C0003X
WACF.601147073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6019293Medicaid
1376659151Medicare UPIN
501806Medicare UPIN