Provider Demographics
NPI:1982794947
Name:CONSONUS PHARMACY SERVICES WASHINGTON LLC
Entity Type:Organization
Organization Name:CONSONUS PHARMACY SERVICES WASHINGTON LLC
Other - Org Name:CONSONUS PHARMACY SERVICES WASHINGTON LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-206-5172
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY STE 101
Mailing Address - Street 2:STE 101
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-4628
Mailing Address - Country:US
Mailing Address - Phone:971-206-5205
Mailing Address - Fax:503-961-7781
Practice Address - Street 1:14729 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6500
Practice Address - Country:US
Practice Address - Phone:877-311-1499
Practice Address - Fax:503-961-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WAPHAR.CF.000588193336L0003X
WAFL000588193336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2109017OtherPK
WA6029516Medicaid
WA6029516Medicaid