Provider Demographics
NPI:1124875521
Name:TUKWILA STATION PHARMACY
Entity type:Organization
Organization Name:TUKWILA STATION PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIKADIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-388-3807
Mailing Address - Street 1:15320 33RD AVE S UNIT 222
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-5114
Mailing Address - Country:US
Mailing Address - Phone:206-388-3807
Mailing Address - Fax:206-388-3809
Practice Address - Street 1:15320 33RD AVE S UNIT 222
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-5114
Practice Address - Country:US
Practice Address - Phone:206-388-3807
Practice Address - Fax:206-388-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy