South Park Rexall Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHARCF00000804 Issued in WA

Legal business name

SOUTH PARK REXALL PHARMACY, INC.

Doing business as

South Park Pharmacy

Practice address

1743 Village LN SE
Port Orchard, WA 98366-2643

Phone

(360) 871-1020

Fax

(360) 871-1213

NPI assigned

Sep 20, 2006

Last updated

May 4, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth Paskett, RPH

Title

Owner

Phone

(360) 871-1020

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• SOUTH PARK PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1437256278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1743 VILLAGE LN SE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662643",
            "telephone_number": "360-871-1020",
            "fax_number": "360-871-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1743 VILLAGE LN SE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662643",
            "telephone_number": "360-871-1020",
            "fax_number": "360-871-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK REXALL PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "PASKETT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-871-1020",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "PHARCF00000804",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4911649",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6174205",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Port Orchard, WA
• Providers in Port Orchard, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; 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.