K-C Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00002121 Issued in WA

Legal business name

K-C PHARMACY INC

Doing business as

Goldendale Pharmacy
K-C Pharmacy Inc

Practice address

104 W Main St
Goldendale, WA 98620-9589

Phone

(509) 773-4344

Fax

(509) 773-4555

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Jeffrey Shane Harrell, PHARMD

Title

Vice President

Phone

(509) 773-4344

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Goldendale Pharmacy Doing business as
• K-C Pharmacy Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1467533687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W MAIN ST",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209589",
            "telephone_number": "509-773-4344",
            "fax_number": "509-773-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W MAIN ST",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209589",
            "telephone_number": "509-773-4344",
            "fax_number": "509-773-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K-C PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "509-773-4344",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00002121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4910700",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "611904",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goldendale Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "K-C Pharmacy Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "K-C Pharmacy Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Klickitat County
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• Klickitat County

• Community/Retail Pharmacy in Goldendale, WA
• Providers in Goldendale, 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 Feb 15, 2022; 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.