Provider Demographics
NPI:1770799983
Name:ETS CONSULTING LLC
Entity type:Organization
Organization Name:ETS CONSULTING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-672-5809
Mailing Address - Street 1:24255 VAN RY BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5460
Mailing Address - Country:US
Mailing Address - Phone:425-356-3276
Mailing Address - Fax:425-356-3101
Practice Address - Street 1:24255 VAN RY BLVD STE A2
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5460
Practice Address - Country:US
Practice Address - Phone:425-356-3276
Practice Address - Fax:425-356-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336M0002X, 3336S0011X
WAPHAR.CF.606918453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028393Medicaid
2108573OtherPK
5542150001Medicare NSC