Organization
JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Active
Other names
Jefferson Healthcare Port Ludlow Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE GLENN (CEO)
(360) 385-2200
Entity
Organization
Contact information
Practice address
9481 OAK BAY RD STE A, PORT LUDLOW, WA 98365-9801
(360) 379-2254
(360) 379-2257
Mailing address
PO BOX 104548, PASADENA, CA 91189-4548
(360) 385-2200
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2126465
—
WA
01
—
PHAR.CF.60884025
LICENSE
WA
Enumeration date
09/07/2018
Last updated
12/31/2025
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