Camp Riley Drug Co. Inc
Organization Active NPI Pharmacy · Monroe, WA
NPI 1235136169 · NPPES record last updated Aug 2, 2022
Key facts
- NPI
- 1235136169
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- Legal business name
- CAMP RILEY DRUG CO. INC
- Practice address
- 17788 147TH St SE
Monroe, WA 98272-1030 - Phone
- (360) 794-7351
- Fax
- (360) 805-5271
- NPI assigned
- Jul 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Bridgett A Edgar, MANAGER
- Title
- Manager
- Phone
- (360) 794-7351
Practitioners 12
-
Shawnett Stenberg, RPH
-
Jeff Kauffman, RPH
-
Cindi Deslys Kenner, RPH
-
Daniel D Kim, PHARM.D.
-
Daniel Lee McManus, RPH
-
Gary O Smith, RPH
-
Keith J Vanderhouwen, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071006000040 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 9931294881 | Practice locations: Monroe, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
1835P0018X | |||
| Ambulatory Care Pharmacist |
1835P2201X | |||
| Clinical Pharmacology Physician |
208U00000X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | 315001080 | WA | |
| Pharmacy | 333600000X | Yes |
Addresses
Primary practice location
17788 147TH St SE
Monroe, WA 98272-1030
Mailing address
17788 147TH St SE
Monroe, WA 98272-1030
Phone (360) 794-7351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6160006 | Medicaid | WA |
Other names
- Pharm A Save Monroe
Other providers in Monroe, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2022. 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.