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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