1255841359 NPI number — COST LESS PHARMACY AND WELLNESS LLC

Table of content: (NPI 1255841359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255841359 NPI number — COST LESS PHARMACY AND WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COST LESS PHARMACY AND WELLNESS 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:
Provider Other Organization Name Type Code:
6
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:
1255841359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1375 REGENTS BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FIRCREST
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98466-6039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-564-1104
Provider Business Mailing Address Fax Number:
253-565-2023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 REGENTS BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FIRCREST
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-564-1104
Provider Business Practice Location Address Fax Number:
253-565-2023
Provider Enumeration Date:
10/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
HIEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
253-564-1104

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: PHAR.CF.60787458 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2171805 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2091478 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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