Provider Demographics
NPI:1457904625
Name:UNIVERSITY OF WASHINGTON
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON
Other - Org Name:UW MEDICINE SOUTH LAKE UNION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIJALKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-744-3377
Mailing Address - Street 1:1959 NE PACIFIC ST # 356015
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-6059
Mailing Address - Fax:206-598-6075
Practice Address - Street 1:750 REPUBLICAN ST BLDG F
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4766
Practice Address - Country:US
Practice Address - Phone:206-520-8380
Practice Address - Fax:206-598-8334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-17
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4939205OtherNCPDP
WA2168487Medicaid