Nooksack Valley Drug Store LLC
Organization Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Everson, WA
NPI 1184764458 · NPPES record last updated Feb 10, 2023
Key facts
- NPI
- 1184764458
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
- Legal business name
- NOOKSACK VALLEY DRUG STORE LLC
- Practice address
- 208 E Main St
Everson, WA 98247-0307 - Phone
- (360) 966-3481
- Fax
- (360) 966-3083
- NPI assigned
- Feb 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Meagan Kammenga
- Title
- Owner
- Phone
- (360) 966-3481
Corporate family (same tax ID) 1
Practitioners 3
-
Meagan Kammenga, PHARMD
-
Andrew Moore, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930017488 | WA | DME Supplier - Pharmacy | 8123166683 | Practice locations: Everson, WA |
| O20190909001628 | WA | Part B Supplier - Pharmacy | 8123166683 | Practice locations: Everson, WA |
National Provider Directory
- Tax ID family
- Nooksack Valley Drug Store LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
1835P0018X | Yes | ||
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
208 E Main St
Everson, WA 98247-0307
Mailing address
PO Box 307
208 E Main St
Everson, WA 98247-0307
Phone (360) 966-3481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6020663 | Medicaid | WA |
Other names
- Valley Drug
Other providers in Everson, WA
- Nooksack Central Management System
- Nooksack Central Management System
- Nooksack Dental Clinic
- Nooksack Indian Tribe
- Nooksack Tribes Genesis II
- Nooksack Valley Drug Store LLC
- Nooksack Valley School District
- William Michael O'Bryan VI
- Lynnette Jo Ondeck
- Silvia Aracely Ortiz
All providers in Everson, WA · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.