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Organization
COUNTRY DOCTOR COMMUNITY CLINIC
Active
Organization
COUNTRY DOCTOR COMMUNITY CLINIC
Active
Other names
Country Doctor Community Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA SAUCEDO (CREDENTIALING SPECIALIST)
(206) 709-7112
Entity
Organization
Contact information
Practice address
510 19TH AVE E, SEATTLE, WA 98112-4095
(206) 709-7116
(206) 299-1608
Mailing address
510 19TH AVE E, SEATTLE, WA 98112-4095
(206) 709-7116
(206) 299-1920
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
CF00004729
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHAR.CF.61403411
LICENSE NUMBER
WA
Enumeration date
05/02/2007
Last updated
01/26/2024
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