1609117944 NPI number — PHARMADREAM INC

Table of content: (NPI 1609117944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609117944 NPI number — PHARMADREAM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHARMADREAM 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:
GARFIELD 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:
1609117944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOHN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99171-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-648-3430
Provider Business Mailing Address Fax Number:
509-648-3217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 N 3RD ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-648-3430
Provider Business Practice Location Address Fax Number:
509-648-3217
Provider Enumeration Date:
03/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WELCH
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
509-648-3430

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 60341889 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4935182 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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