Organization
EASTERN STATE HOSPITAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONDA D KENNEY MPA (CHIEF OPERATING OFFICER)
(509) 565-4659
Entity
Organization
Contact information
Practice address
800 WEST MAPLE STREET, MEDICAL LAKE, WA 99022-0800
(509) 299-3121
(509) 299-7015
Mailing address
850 MAPLE STREET, MEDICAL LAKE, WA 99022
(509) 565-4659
(509) 565-7015
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
11/02/2006
Last updated
10/15/2018
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