Tick Klock Drug LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00000865 Issued in WA

Legal business name

TICK KLOCK DRUG LLC

Practice address

109 S Main St
Colfax, WA 99111-1803

Phone

(509) 397-2111

Fax

(509) 397-4947

NPI assigned

Aug 10, 2006

Organization subpart

No

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

Authorized official

Name

Nathan Johnson, PHARMDNPI 1871212274

Title

Owner/ Pharmacist

Phone

(509) 397-2111

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• TICK KLOCK DRUGS LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 5

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

• Nathan Johnson, PHARMD

  • Pharmacist
  • Colfax, WA
  • NPI 1871212274
  NPD Authorized official
• Hunter Bud Weitze, RPH

  • Pharmacist
  • Colfax, WA
  • NPI 1710607239
  NPD
• Carmen Gwinn, PHARMD

  • Pharmacist
  • Colfax, WA
  • NPI 1700700333
  NPD (past)
• Kaitlynn Johnson, PHARMD

  • Pharmacist
  • Davenport, WA
  • NPI 1053030452
  NPD (past)
• Brooke Morse, PHARMD

  • Pharmacist
  • Colfax, WA
  • NPI 1114646510
  NPD (past)

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1215948716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "COLFAX",
            "state": "WA",
            "postal_code": "991110189",
            "telephone_number": "509-397-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S MAIN ST",
            "city": "COLFAX",
            "state": "WA",
            "postal_code": "991111803",
            "telephone_number": "509-397-2111",
            "fax_number": "509-397-4947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TICK KLOCK DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER/ PHARMACIST",
        "authorized_official_telephone_number": "509-397-2111",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00000865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6009641",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2106591",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TICK KLOCK DRUGS LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TICK KLOCK DRUGS LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert Terry Smith, D.D.S.
• Brenna St John
• Erin Nicole Startin, ATC/L, LMP
• Paul B Sullivan, CRNA
• Three Forks Orthopaedics PC
• John Lyle Turner, DMD
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• Jaime Mellor Vantine, FNP-C
• Volunteer Firemen, Inc.
• Jo Frances Wagner, M.S.

• All providers in Colfax, WA
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.