NPIMap

Organization Active NPI

Nooksack Valley Drug Store LLC

Doing business as Valley Drug

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Everson, WA
National Provider Identifier
1184764458
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X
Legal business name
NOOKSACK VALLEY DRUG STORE LLC
Doing business as
Valley Drug
Practice address
208 E Main St
Everson, WA 98247-0307
Phone
(360) 966-3481
Fax
(360) 966-3083
NPI assigned
Feb 7, 2007
Last updated
Feb 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2023

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

Authorized official

Name
Mrs. Meagan KammengaNPI 1568651057
Title
Owner
Phone
(360) 966-3481

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 1835P0018X Primary
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 names 1

  • Valley Drug Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930017488 WA DME Supplier - Pharmacy 8123166683 Practice locations: Everson, WA
O20190909001628 WA Part B Supplier - Pharmacy 8123166683 Practice locations: Everson, WA

National Provider Directory

National Provider Directory
Tax ID family
Nooksack Valley Drug Store LLC2 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 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1184764458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 307",
            "address_2": "208 E MAIN ST",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982470307",
            "telephone_number": "360-966-3481",
            "fax_number": "360-966-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 E MAIN ST",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982470307",
            "telephone_number": "360-966-3481",
            "fax_number": "360-966-3083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOOKSACK VALLEY DRUG STORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "KAMMENGA",
        "authorized_official_first_name": "MEAGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-966-3481",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Drug",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everson, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.