Overlake Medical Tower Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00056713 Issued in WA

Legal business name

OVERLAKE MEDICAL TOWER PHARMACY

Practice address

1135 116TH Ave NE
Ste 105
Bellevue, WA 98004-4623

Phone

(425) 688-5958

Fax

(425) 467-3540

NPI assigned

Apr 20, 2007

Last updated

Sep 13, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Annie Lee, PHD

Title

Phcy MNGR

Phone

(425) 688-5958

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Overlake Hosp Med CNTR4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Over Lake Medical Center

  • Medical Specialty Clinic/Center
  • Bellevue, WA
  • NPI 1770971830
  NPD tax ID
• Overlake Hospital Medical Center

  • General Acute Care Hospital
  • Bellevue, WA
  • NPI 1285848432
  NPD tax ID
• Overlake Medical Center & Clinics

  • General Acute Care Hospital
  • Bellevue, WA
  • NPI 1598971855
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1043437890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE",
            "address_2": "STE 105",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 116TH AVE NE",
            "address_2": "STE 105",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980044623",
            "telephone_number": "425-688-5958",
            "fax_number": "425-467-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVERLAKE MEDICAL TOWER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_title_or_position": "PHCY MNGR",
        "authorized_official_telephone_number": "425-688-5958",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00056713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "4928151",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6023584",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Overlake Medical Center & Clinics
• Overlake Medical Center & Clinics
• Overlake Medical Center & Clinics
• Overlake Medical Clinics LLC
• Overlake Medical Clinics, LLC
• Overlake Neurology
• Overlake Obstetricians & Gynecologist P S
• Overlake Reproductive Health Inc PS. (Overlake Reproductive Health Inc.- Ambulatory Surgical Facility)
• Overlake Reproductive Health Inc., PS
• Overlake Reproductive Health Lab and Surgical Services, LLC

• Community/Retail Pharmacy in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.