NPIMap

Organization Active NPI

Chinook Pharmacy Clinical

  • Family Medicine Physician
  • Forks, WA
National Provider Identifier
1417528282
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHINOOK PHARMACY CLINICAL
Practice address
11 S Forks Ave Ste a
Forks, WA 98331-9006
Phone
(360) 374-2294
Fax
(360) 374-5057
NPI assigned
Jul 2, 2021
Organization subpart
Yes
Parent organization
CHINOOK PHARMACY INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Charles Edward Carlson, RPH
Title
Owner/RPH
Phone
(360) 374-2294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

11 S Forks Ave Ste a
Forks, WA 98331-9006

Mailing address

PO Box 2136
Forks, WA 98331-2136
Phone (360) 374-2294

Other names 1

  • Chinook Pharmacy INC. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Chinook Pharmacy Clinical2 organizations share this tax ID, including this one
Part of
Chinook Pharmacy Clinical

Other organizations with this tax ID 1

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

Locations

11 S Forks Ave
Ste A
Forks, WA 98331
Phone (360) 374-2294

NPI Registry JSON

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1417528282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2136",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983312136",
            "telephone_number": "360-374-2294",
            "fax_number": "360-374-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S FORKS AVE STE A",
            "city": "FORKS",
            "state": "WA",
            "postal_code": "983319006",
            "telephone_number": "360-374-2294",
            "fax_number": "360-374-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHINOOK PHARMACY CLINICAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHINOOK PHARMACY INC.",
        "enumeration_date": "2021-07-02",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER/RPH",
        "authorized_official_telephone_number": "360-374-2294",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chinook Pharmacy INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forks, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.