1033112883 NPI number — COST PLUS PRESCRIPTIONS, INC.

Table of content: (NPI 1033112883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033112883 NPI number — COST PLUS PRESCRIPTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COST PLUS PRESCRIPTIONS, INC.
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:
Provider Other Organization Name Type Code:
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:
1033112883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 N I ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98403-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-572-9018
Provider Business Mailing Address Fax Number:
253-627-7685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 N I ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98403-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-9018
Provider Business Practice Location Address Fax Number:
253-627-7685
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-572-9018

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 333600000X , with the licence number: 026202CF00002490 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 14504 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9040379 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7331093 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6018006 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO3219 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9045956 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AB09090 . This is a "MEDICARE ROSTER BILLER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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