NPIMap

Organization Active NPI

Sixth Avenue Medical Pharmacy Inc

  • Pharmacy
  • Spokane, WA
National Provider Identifier
1124039623
Registry record updated Jun 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHAR.CF.60411553 Issued in WA
Legal business name
SIXTH AVENUE MEDICAL PHARMACY INC
Practice address
508 W 6TH Ave
Spokane, WA 99204-2770
Phone
(509) 455-9345
Fax
(509) 455-4479
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2016

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

Authorized official

Name
Erik NelsonNPI 1215377544
Title
Pic
Phone
(509) 455-9345

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X PHAR.CF.60411553 WA Primary
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

508 W 6TH Ave
Spokane, WA 99204-2770

Mailing address

508 W 6TH Ave
Ste 104
Spokane, WA 99204-2770
Phone (509) 455-9345

Other identifiers 2

IdentifierTypeStateIssuer
6154702MedicaidWA
2143800OtherPK

Other names 1

  • Sixth Avenue Medical Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930075786 WA DME Supplier - Pharmacy 6305963489 Practice locations: Spokane, WA
O20130604000123 WA Part B Supplier - Mass Immunization (Roster Biller Only) 6305963489 Practice locations: Spokane, WA

National Provider Directory

National Provider Directory
Tax ID family
Sixth Avenue LTC Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466467200000",
    "number": "1124039623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 W 6TH AVE",
            "address_2": "STE 104",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042770",
            "telephone_number": "509-455-9345",
            "fax_number": "509-455-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 W 6TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042770",
            "telephone_number": "509-455-9345",
            "fax_number": "509-455-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIXTH AVENUE MEDICAL PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2016-06-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "509-455-9345"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60411553",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6154702",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sixth Avenue Medical Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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.