1831104454 NPI number — ETS CONSULTING LLC

Table of content: (NPI 1831104454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831104454 NPI number — ETS CONSULTING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ETS CONSULTING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHIRAZ SPECIALTY PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831104454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24255 VAN RY BLVD STE A1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTLAKE TERRACE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98043-5460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-356-3276
Provider Business Mailing Address Fax Number:
425-356-3101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24255 VAN RY BLVD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTLAKE TERRACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98043-5460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-356-3276
Provider Business Practice Location Address Fax Number:
425-356-3101
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOANE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
425-672-5809

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHARM.CF.60691335 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2108647 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6028393 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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