NPIMap

Organization Active NPI

Multicare Health Systems

Doing business as MultiCare Good Sam Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Puyallup, WA
National Provider Identifier
1457629644
Registry record updated Sep 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHARCF60229229 Issued in WA
Legal business name
MULTICARE HEALTH SYSTEMS
Doing business as
MultiCare Good Sam Outpatient Pharmacy
Practice address
401 15TH Ave SE
Puyallup, WA 98372-3715
Phone
(253) 697-3494
NPI assigned
Dec 2, 2011
Last updated
Sep 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MULTICARE HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2021

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

Authorized official

Name
Teresa Diane Harberg, PHARMD
Title
Director, Ambulatory Pharmacy
Phone
(253) 426-6209

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X PHARCF60229229 WA Primary

Addresses

Primary practice location

401 15TH Ave SE
Puyallup, WA 98372-3715

Mailing address

401 15TH Ave SE
Puyallup, WA 98372-3715
Phone (253) 697-3494

Other identifiers 2

IdentifierTypeStateIssuer
2132866OtherPK
2015487MedicaidWA

Other names 1

  • MultiCare Good Sam Outpatient Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201222003022 WA Part B Supplier - Mass Immunization (Roster Biller Only) 7719899897 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tacoma, WA; Burien, WA; Spokane, WA; Puyallup, WA; Auburn, WA; Bonney Lake, WA; Covington, WA; Gig Harbor, WA
O20201231000479 WA Part B Supplier - Pharmacy 7719899897 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gig Harbor, WA; Tacoma, WA; Spokane, WA; Puyallup, WA; Covington, WA; Burien, WA; Bonney Lake, WA; Auburn, WA

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
MMG Westgate Urgent Car99 organizations share this tax ID, including this one
Part of
MMG Westgate Urgent Car

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1450 5th St SE
Ste 1200
Puyallup, WA 98372
Phone (253) 697-4747

NPI Registry JSON

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1457629644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 15TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723715",
            "telephone_number": "253-697-3494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 15TH AVE SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723715",
            "telephone_number": "253-697-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTICARE HEALTH SYSTEMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MULTICARE HEALTH SYSTEM",
        "enumeration_date": "2011-12-02",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "HARBERG",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "DIRECTOR, AMBULATORY PHARMACY",
        "authorized_official_telephone_number": "253-426-6209",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHARCF60229229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132866",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015487",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MultiCare Good Sam Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.