Bainbridge Island Community Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BAINBRIDGE ISLAND COMMUNITY PHARMACY LLC

Practice address

124 Winslow Way W
Bainbridge Island, WA 98110-2512

Phone

(206) 780-7809

Fax

(206) 842-7801

NPI assigned

Mar 6, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Jowett Tan

Title

Member

Phone

(206) 780-7809

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Bainbridge Island Community Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wayne Tim Luk, RPH

  • Pharmacist
  • Bainbridge Island, WA
  • NPI 1780707083
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1073053302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 WINSLOW WAY W",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102512",
            "telephone_number": "206-780-7809",
            "fax_number": "206-842-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 WINSLOW WAY W",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102512",
            "telephone_number": "206-780-7809",
            "fax_number": "206-842-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAINBRIDGE ISLAND COMMUNITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "MARK JOWETT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "206-780-7809"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2082015",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2168189",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bainbridge Island Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda Anne Ayriss, LMFT
• Melannie Leigh Babboni, LMP
• Bainbridge Advanced Care Ambulance
• Bainbridge Dental Care, PS
• Bainbridge Island Ambulance Association Inc
• Bainbridge Island Physical Therapy, LLC
• Bainbridge Island School District
• Bainbridge Mental Health, PLLC
• Bainbridge Pediatric Therapy
• Bainbridge Pediatrics, PLLC

• Community/Retail Pharmacy in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.