NPIMap

Organization Active NPI

International Community Health Services

  • Community/Retail Pharmacy
  • Seattle, WA
National Provider Identifier
1508990631
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00058776 Issued in WA
Legal business name
INTERNATIONAL COMMUNITY HEALTH SERVICES
Practice address
3815 S Othello St FL 2
Seattle, WA 98118-3510
Phone
(206) 788-3563
Fax
(206) 788-2369
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Authorized official

Name
Hermes Shahbazian
Title
Cfo
Phone
(206) 788-3618

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X CF00058776 WA Primary

Addresses

Primary practice location

3815 S Othello St FL 2
Seattle, WA 98118-3510

Mailing address

3815 S Othello St FL 2
Seattle, WA 98118-3510
Phone (206) 788-3563

Other identifiers 1

IdentifierTypeStateIssuer
6029540MedicaidWA

Other names 1

  • ICHS Holly Park Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210129000988 WA Part B Supplier - Mass Immunization (Roster Biller Only) 5799695672 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seattle, WA; Shoreline, WA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
International Community Health Services33 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611619200000",
    "number": "1508990631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 S OTHELLO ST FL 2",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183510",
            "telephone_number": "206-788-3563",
            "fax_number": "206-788-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 S OTHELLO ST FL 2",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981183510",
            "telephone_number": "206-788-3563",
            "fax_number": "206-788-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A",
        "authorized_official_last_name": "SHAHBAZIAN",
        "authorized_official_first_name": "HERMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "206-788-3618"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00058776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6029540",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ICHS Holly Park Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.