EASTERN STATE HOSPITAL PHARMACY (NPI# 1679651970) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679651970 |
| Entity Type | Organization |
| Organization Name | EASTERN STATE HOSPITAL PHARMACY |
| Practice Address |
800 West Maple Street Medical Lake WA 99022-0800 |
| Mailing Address |
850 Maple Street Medical Lake WA 99022 |
| Practice Telephone | 5092993121 |
| Practice Fax Number | 5092997015 |
| Mailing Telephone | 5095654659 |
| Mailing Fax Number | 5095657015 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-10-15 |
| Authorized Official Name | RONDA D KENNEY (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 5095654659 |
| Authorized Official Credential | MPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 283Q00000X | Psychiatric Hospital | Hospitals | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| Street Address |
800 WEST MAPLE STREET |
| City | MEDICAL LAKE |
| State | WA |
| Zip Code | 99022-0800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437149440 | Imelda D. Goyanko-borrowmeo | Psychiatry & Neurology | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2005-10-21 |
| 1316299381 | Sabrina Arnott Keckalo | Physician Assistant | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2012-10-15 |
| 1912223454 | Robert Cory Fanto | Psychologist | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2010-04-08 |
| 1184955874 | Sandra D Phillips | Dental Hygienist | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2010-01-20 |
| 1508013764 | Nosrat Aflatooni | Physician Assistant | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2008-08-19 |
| 1275793671 | Miranda J Gordon | Occupational Therapist | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2008-06-10 |
| 1043488570 | Michelle D Wellman | Occupational Therapy Assistant | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2008-02-19 |
| 1689749277 | Timothy J Pinnell | Occupational Therapy Assistant | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2006-11-21 |
| 1225107287 | Janice L Williams | Dental Hygienist | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2006-11-06 |
| 1881763928 | Marcia L Ryan | Speech-Language Pathologist | 800 West Maple Street, Medical Lake, WA 99022-0800 | 2006-11-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417462227 | Alicia Burton Dds Pllc | Clinic/Center | 47 E. Wa 902, Medical Lake, WA 99022 | 2017-12-04 |
| 1487100038 | Tammy Lee Adler | Pharmacist | 1010 W Fir St, Medical Lake, WA 99022 | 2016-09-01 |
| 1902281959 | Carmen Joy Berg | Pharmacist | 2320 South Salnave Road, Medical Lake, WA 99022 | 2015-07-20 |
| 1033546288 | Torrance Whitney Baldwin | Speech-Language Pathologist | 116 West 3rd St., Medical Lake, WA 99022 | 2013-10-02 |
| 1144572710 | Keri Lea Wissink | Speech-Language Pathologist | 116 West Thrird Street, Medical Lake, WA 99022 | 2012-10-08 |
| 1609153766 | Dutton Veterinary Medicine Pllc | Special Hospital | 212 East Lake Street, Medical Lake, WA 99022 | 2011-11-03 |
| 1881912962 | Susan L Vanwormer | Counselor | 108 N. Jefferson, Medical Lake, WA 99022 | 2010-05-13 |
| 1467774232 | Ryan K Love | Dentist | N 123 Brower Street, Medical Lake, WA 99022 | 2010-02-22 |
| 1023263464 | Emily S Mildes | Nurse Practitioner | 1451 W Maple, Medical Lake, WA 99022 | 2008-11-26 |
| 1619005014 | Maria Lydia Montenegro | General Practice | 2320 Salnave Rd, Lakeland Village, Medical Lake, WA 99022 | 2007-02-28 |
| Find all providers in zip 99022 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457414138 | Washington State Dept of Social and Health Services | Pharmacy | S 2320 Salnave Road, Medical Lake, WA 99022-0200 | 2006-12-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316577869 | Ksr Health Care LLC | Pharmacy | 507 W Stevens Ave Ste Aaa, Sultan, WA 98294-9515 | 2020-01-23 |
| 1730724105 | Silver Lake Pharmacy Inc | Pharmacy | 10315 19th Ave Se Ste 104, Everett, WA 98208-4268 | 2019-11-09 |
| 1437708641 | Ets Consulting LLC | Pharmacy | 6007 244th St Sw Ste A1, Mountlake Terrace, WA 98043-5427 | 2019-09-10 |
| 1891341616 | Nwpa Inc | Pharmacy | 21509 State Route 410 E Ste 4, Bonney Lake, WA 98391-4104 | 2019-08-16 |
| 1669033288 | Suncrest Pharmacy Group, LLC | Pharmacy | 5919f Highway 291, Nine Mile Falls, WA 99026 | 2019-06-25 |
| 1750948956 | Lacey Square Pharmacy Inc | Pharmacy | 6020 Pacific Ave Se Ste C, Lacey, WA 98503-1319 | 2019-05-22 |
| 1306338868 | Manhattan Village Pharmacy Inc. | Pharmacy | 10102 E Knox Ave Ste 400, Spokane Valley, WA 99206-4146 | 2018-05-31 |
| 1528566981 | Rxltc, Pllc | Pharmacy | 969 Stevens Dr Ste 1b, Richland, WA 99352 | 2018-01-31 |
| 1891167755 | Think Different | Pharmacy | 31710 50th Ln Sw Apt V201, Federal Way, WA 98023-3747 | 2015-10-30 |
| 1104207372 | Prescription Pharmacy Pllc | Pharmacy | 800 Swift Blvd Ste 140, Richland, WA 99352-3559 | 2015-06-14 |
| Find all providers with the same taxonomy | ||||
| City | MEDICAL LAKE |
| Zip Code | 99022 |
Please comment or provide details below to improve the information on EASTERN STATE HOSPITAL PHARMACY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.