Provider Demographics
NPI:1245861996
Name:SALISH INTEGRATIVE MEDICINE, INC
Entity type:Organization
Organization Name:SALISH INTEGRATIVE MEDICINE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-382-6300
Mailing Address - Street 1:3700 PACIFIC HWY E STE 100
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1160
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:253-382-6301
Practice Address - Street 1:3700 PACIFIC HWY E STE 100B
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1160
Practice Address - Country:US
Practice Address - Phone:253-382-6312
Practice Address - Fax:253-382-6301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALISH INTEGRATIVE MEDICINE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-31
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy