14TH Avenue Pharmacy Inc.
Organization Active NPI Community/Retail Pharmacy · Pasco, WA
NPI 1629028378 · NPPES record last updated Feb 20, 2009
Key facts
- NPI
- 1629028378
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- CF00057982 (WA)
- Legal business name
- 14TH AVENUE PHARMACY INC.
- Practice address
- 1200 N 14TH Ave
Suite 100
Pasco, WA 99301-4182 - Phone
- (509) 547-8360
- NPI assigned
- May 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Scott Louderback, PHARM D
- Title
- President
- Phone
- (402) 489-1135
National Provider Directory
Locations
8055 O St
Ste 201
Lincoln, NE 68510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | CF00057982 | WA | Yes |
Addresses
Primary practice location
1200 N 14TH Ave
Suite 100
Pasco, WA 99301-4182
Mailing address
8055 O St
Suite 201
Lincoln, NE 68510-2564
Phone (402) 489-1135
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6005128 | Medicaid | WA |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.