Basic Information
| Provider Information | |||||||||
| NPI: | 1821218876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CENTERS OF KING COUNTY | ||||||||
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| OtherOrganizationName: | KENT COMMUNITY HEALTH CENTER PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E MEEKER ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980305904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533723661 | ||||||||
| FaxNumber: | 2533723663 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 POWELL AVE SW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980552908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252771311 | ||||||||
| FaxNumber: | 4252771566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TROMPETER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4252771311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | CF00059025 | WA | Y | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4932314 | 01 | WA | NATIONAL ASSOC BOARD OF P | OTHER |