NPIMap

Organization Active NPI

Muckleshoot Health and Wellness Center Pharmacy

Doing business as Muckleshoot HWC Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Auburn, WA
National Provider Identifier
1225241581
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
MUCKLESHOOT HEALTH AND WELLNESS CENTER PHARMACY
Doing business as
Muckleshoot HWC Pharmacy
Practice address
17500 SE 392ND St
Attn Pharmacy
Auburn, WA 98092-9705
Phone
(253) 333-3618
Fax
(253) 333-6853
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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

Authorized official

Name
Mr. Matthew Berg, PHARM D.
Title
Pharmacy Director
Phone
(253) 333-3619

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X WA Primary

Addresses

Primary practice location

17500 SE 392ND St
Attn Pharmacy
Auburn, WA 98092-9705

Mailing address

17500 SE 392ND St
Attn Pharmacy
Auburn, WA 98092-9705
Phone (253) 333-3618

Other identifiers 1

IdentifierTypeStateIssuer
6016752MedicaidWA

Other names 1

  • Muckleshoot HWC Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Muckleshoot Indian Heal3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478649600000",
    "number": "1225241581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17500 SE 392ND ST",
            "address_2": "ATTN PHARMACY",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980929705",
            "telephone_number": "253-333-3618",
            "fax_number": "253-333-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17500 SE 392ND ST",
            "address_2": "ATTN PHARMACY",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980929705",
            "telephone_number": "253-333-3618",
            "fax_number": "253-333-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUCKLESHOOT HEALTH AND WELLNESS CENTER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2016-11-09",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "253-333-3619",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM D."
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6016752",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Muckleshoot HWC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.