Provider Demographics
NPI:1013950393
Name:WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Entity Type:Organization
Organization Name:WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Other - Org Name:FIRCREST SCHOOL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-361-3032
Mailing Address - Street 1:15230 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7130
Mailing Address - Country:US
Mailing Address - Phone:206-361-3565
Mailing Address - Fax:206-361-3157
Practice Address - Street 1:15230 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7130
Practice Address - Country:US
Practice Address - Phone:206-361-3565
Practice Address - Fax:206-361-3157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFL00000256333600000X, 3336I0012X, 3336L0003X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4906650OtherOTHER ID NUMBER