NPIMap

Organization Active NPI

Sagen's Pharmacy Inc

Doing business as Raymond Pharmacy

  • Community/Retail Pharmacy
  • Raymond, WA
National Provider Identifier
1508962531
Registry record updated Oct 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00059361 Issued in WA
Legal business name
SAGEN'S PHARMACY INC
Doing business as
Raymond Pharmacy
Practice address
515 Commercial St
Raymond, WA 98577-2509
Phone
(360) 942-2634
Fax
(360) 942-5132
NPI assigned
Sep 16, 2006
Last updated
Oct 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2016

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

Authorized official

Name
Mr. Jeff Shane Harrell
Title
Owner
Phone
(360) 642-3133

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X CF00001625 WA
Community/Retail Pharmacy 3336C0003X CF00059361 WA Primary

Addresses

Primary practice location

515 Commercial St
Raymond, WA 98577-2509

Mailing address

PO Box 591
Raymond, WA 98577-2509
Phone (360) 942-2634

Other identifiers 1

IdentifierTypeStateIssuer
6060602MedicaidWA

Other names 1

  • Raymond Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081217000672 WA Part B Supplier - Mass Immunization (Roster Biller Only) 9537221064 Practice locations: Raymond, WA
O20100930013510 WA DME Supplier - Pharmacy 9537221064 Practice locations: Raymond, WA

National Provider Directory

National Provider Directory
Tax ID family
Sagen's Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

515 Commercial St
Raymond, WA 98577
Phone (360) 942-2634

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477612800000",
    "number": "1508962531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 591",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772509",
            "telephone_number": "360-942-2634",
            "fax_number": "360-942-5132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 COMMERCIAL ST",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772509",
            "telephone_number": "360-942-2634",
            "fax_number": "360-942-5132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGEN'S PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2016-10-28",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-642-3133",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "CF00001625",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00059361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6060602",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raymond Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Raymond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2016; 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.