Provider Demographics
NPI:1356415699
Name:FRED HUTCHINSON CANCER CENTER
Entity type:Organization
Organization Name:FRED HUTCHINSON CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-606-4358
Mailing Address - Street 1:825 EASTLAKE AVE E
Mailing Address - Street 2:G5900
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1023
Mailing Address - Country:US
Mailing Address - Phone:206-606-6500
Mailing Address - Fax:206-606-2040
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:G5900
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1023
Practice Address - Country:US
Practice Address - Phone:206-288-1375
Practice Address - Fax:206-288-1380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRED HUTCHINSON CANCER CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000568463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6024046Medicaid
4928694OtherNCPDP
4928694OtherNCPDP
WA4352590001Medicare NSC