Organization
PUBLIC HOSPITAL DISTRICT #1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ISHIZUKA (CFO)
(360) 814-5838
Entity
Organization
Contact information
Practice address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 424-4111
Mailing address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 424-4111
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H-207
WA
333600000X
Pharmacy
—
—
3336I0012X
Institutional Pharmacy
H-2017
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6004600
—
WA
Enumeration date
11/21/2006
Last updated
12/08/2017
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