1932260817 NPI number — CATHLAMET PHARMACY

Table of content: (NPI 1932260817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932260817 NPI number — CATHLAMET PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHLAMET PHARMACY
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:
1932260817
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:
PO BOX 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATHLAMET
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98612-0218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-795-3691
Provider Business Mailing Address Fax Number:
360-795-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATHLAMET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98612-0218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-795-3691
Provider Business Practice Location Address Fax Number:
360-795-3033
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LABERGE
Authorized Official First Name:
ROY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
360-795-3691

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH00007223 , 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: 6031207 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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