NPIMap

Organization Active NPI

Eastern State Hospital Pharmacy

  • Long Term Care Pharmacy
  • Medical Lake, WA
National Provider Identifier
1679651970
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
EASTERN STATE HOSPITAL PHARMACY
Practice address
800 West Maple Street
Medical Lake, WA 99022-0800
Phone
(509) 299-3121
Fax
(509) 299-7015
NPI assigned
Nov 2, 2006
Last updated
Oct 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

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

Authorized official

Name
Ronda D Kenney, MPA
Title
Chief Operating Officer
Phone
(509) 565-4659

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

800 West Maple Street
Medical Lake, WA 99022-0800

Mailing address

850 Maple Street
Medical Lake, WA 99022
Phone (509) 565-4659

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 79

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.

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539561600000",
    "number": "1679651970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 MAPLE STREET",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "99022",
            "telephone_number": "509-565-4659",
            "fax_number": "509-565-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WEST MAPLE STREET",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-299-3121",
            "fax_number": "509-299-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN STATE HOSPITAL PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2018-10-15",
        "status": "A",
        "authorized_official_last_name": "KENNEY",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "509-565-4659",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medical Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.