Ponciano F Bautista specialises in Clinic Pharmacy. currently works in Washington.
NPI Number | 1144859638 |
Provider Name | Ponciano F Bautista |
Credential | |
Specialization | Clinic Pharmacy |
Medical School Name | |
Graduation Year | |
Gender | |
Entity Type | Individual |
PAC ID by PECOS | |
Professional Enrollment ID | |
Enumeration Date | 04/06/2020 |
Last Update Date | 04/06/2020 |
Business Practice address |
4002 49TH AVE S, Seattle, 98118-1228 Washington View on Google Map |
Business Practice phone | 206-834-5647 |
Business Practice fax | |
Mailing address |
4002 49TH AVE S, Seattle, 98118-1228 Washington View on Google Map |
Other phone | 206-834-5647 |
Other fax | 206-323-9206 |
Email Address | shannonfig@domain.com Reval Email Address |
Seattle, Washington
Field Name | Field Value |
---|---|
NPI | 1144859638 |
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
|
Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
|
|
Provider Last Name (Legal Name) | Bautista |
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
Provider First Name | Ponciano |
The first name of the provider, if the provider is an individual. | |
Provider Credential Text | |
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
Provider First Line Business Mailing Address | 4002 49TH AVE S |
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
Provider Business Mailing Address City Name | Seattle |
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
Provider Business Mailing Address State Name | Washington |
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
Provider Business Mailing Address Postal Code | 98118-1228 |
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
Provider Business Mailing Address Country Code | US |
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
Provider Business Mailing Address Telephone Number | 206-834-5647 |
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
Provider Business Mailing Address Fax Number | 206-323-9206 |
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''. | |
Provider First Line Business Practice Location Address | 4002 49TH AVE S |
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
Provider Business Practice Location Address City Name | Seattle |
The city name in the location address of the provider being identified. | |
Provider Business Practice Location Address State Name | Washington |
The State or Province name in the location address of the provider being identified. | |
Provider Business Practice Location Address Postal Code | 98118-1228 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
Provider Business Practice Location Address Country Code | US |
The country code in the location address of the provider being identified. | |
Provider Business Practice Location Address Telephone Number | 206-834-5647 |
The telephone number associated with the location address of the provider being identified. | |
Provider Enumeration Date | 04/06/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). | |
Last Update Date | 04/06/2020 |
The date that a record was last updated or changed. | |
Healthcare Provider Taxonomy Code #1 | 3336C0002X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 1 | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
Healthcare Provider Taxonomy #1 | |
Provider License Number 1 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 1 | WA |
Provider License Number State Code #1 | |
Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #2 | 3336C0003X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 2 | A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Healthcare Provider Taxonomy #2 | |
Provider License Number 2 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 2 | WA |
Provider License Number State Code #2 | |
Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #3 | 3336C0004X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 3 | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
Healthcare Provider Taxonomy #3 | |
Provider License Number 3 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 3 | WA |
Provider License Number State Code #3 | |
Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #4 | 3336H0001X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 4 | Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
Healthcare Provider Taxonomy #4 | |
Provider License Number 4 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 4 | WA |
Provider License Number State Code #4 | |
Healthcare Provider Primary Taxonomy Switch 4 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #5 | 3336I0012X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 5 | A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
Healthcare Provider Taxonomy #5 | |
Provider License Number 5 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 5 | WA |
Provider License Number State Code #5 | |
Healthcare Provider Primary Taxonomy Switch 5 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #6 | 3336L0003X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 6 | A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
Healthcare Provider Taxonomy #6 | |
Provider License Number 6 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 6 | WA |
Provider License Number State Code #6 | |
Healthcare Provider Primary Taxonomy Switch 6 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #7 | 3336M0002X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 7 | A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. |
Healthcare Provider Taxonomy #7 | |
Provider License Number 7 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 7 | WA |
Provider License Number State Code #7 | |
Healthcare Provider Primary Taxonomy Switch 7 | N |
Primary Taxonomy:
|
|
Healthcare Provider Taxonomy Code #8 | 3336M0002X |
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
Healthcare Provider Taxonomy 8 | A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states. |
Healthcare Provider Taxonomy #8 | |
Provider License Number 8 | PH00017744 |
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section. | |
Provider License Number State Code 8 | WA |
Provider License Number State Code #8 | |
Healthcare Provider Primary Taxonomy Switch 8 | Y |
Primary Taxonomy:
|