Provider Demographics
NPI:1972606333
Name:SEA - MAR COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SEA - MAR COMMUNITY HEALTH CENTER
Other - Org Name:SEA MAR COMMUNITY HEALTH CENTERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-762-3397
Mailing Address - Street 1:1040 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4720
Mailing Address - Country:US
Mailing Address - Phone:206-762-3397
Mailing Address - Fax:206-764-8362
Practice Address - Street 1:7438 S D AVE
Practice Address - Street 2:STE C
Practice Address - City:CONCRETE
Practice Address - State:WA
Practice Address - Zip Code:98237-9642
Practice Address - Country:US
Practice Address - Phone:360-853-8109
Practice Address - Fax:360-853-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.605061493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148692OtherPK