Organization
PROVIDENCE HEALTH & SERVICES -WASHINGTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 486-9550
(907) 486-9553
Mailing address
PO BOX 3706, PORTLAND, OR 97208-3706
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PHAR355
AK
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997047
PK
—
Enumeration date
11/11/2005
Last updated
05/15/2025
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