NPIMap

Organization Active NPI

Tulalip Clinical Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Tulalip, WA
National Provider Identifier
1619193570
Registry record updated Jul 21, 2021
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
TULALIP CLINICAL PHARMACY
Practice address
8825 34TH Ave NE
Suite a
Tulalip, WA 98271-8085
Phone
(360) 716-2660
Fax
(360) 716-3660
NPI assigned
Apr 18, 2007
Last updated
Jul 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Margaret Goodman
Title
Pharmacy Coordinator
Phone
(360) 716-2664

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X CF00055944 WA
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X NU Primary
Clinic Pharmacy 3336C0002X CF00055944 WA
Community/Retail Pharmacy 3336C0003X CF00055944 WA

Addresses

Primary practice location

8825 34TH Ave NE
Suite a
Tulalip, WA 98271-8085

Mailing address

8825 34TH Ave NE
Suite a
Tulalip, WA 98271-8085
Phone (360) 716-2660

Other identifiers 1

IdentifierTypeStateIssuer
6019939MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130219000550 WA Part B Supplier - Pharmacy 4880857275 Practice locations: Tulalip, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1619193570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 34TH AVE NE",
            "address_2": "SUITE A",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982718085",
            "telephone_number": "360-716-2660",
            "fax_number": "360-716-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8825 34TH AVE NE",
            "address_2": "SUITE A",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982718085",
            "telephone_number": "360-716-2660",
            "fax_number": "360-716-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULALIP CLINICAL PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "PHARMACY COORDINATOR",
        "authorized_official_telephone_number": "360-716-2664"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WA",
            "license": "CF00055944",
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "WA",
            "license": "CF00055944",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00055944",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6019939",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulalip, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.