Basic Information
| Provider Information | |||||||||
| NPI: | 1043858665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHPOINT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | HEALTHPOINT SEATAC PHARMACY NON-340B | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 POWELL AVE SW | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980572908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252771311 | ||||||||
| FaxNumber: | 4252771566 | ||||||||
| Practice Location | |||||||||
| Address1: | 4040 S 188TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | SEATAC | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981885070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772330246 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2019 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SUTPHEN | ||||||||
| AuthorizedOfficialFirstName: | LUCY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 4252771311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.