Suncrest Pharmacy Group, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SUNCREST PHARMACY GROUP, LLC

Practice address

5919F Highway 291
Nine Mile Falls, WA 99026

Phone

(509) 413-2030

Fax

(509) 413-2091

NPI assigned

Jun 25, 2019

Organization subpart

No

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

Authorized official

Name

Erik Nelson, PHARMD

Title

President

Phone

(509) 455-9345

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Suncrest Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1669033288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX B",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986240167",
            "telephone_number": "360-642-3133",
            "fax_number": "360-642-5133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5919F HIGHWAY 291",
            "city": "NINE MILE FALLS",
            "state": "WA",
            "postal_code": "99026",
            "telephone_number": "509-413-2030",
            "fax_number": "509-413-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCREST PHARMACY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-455-9345",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2142653",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suncrest Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suncrest Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindsay D Sanders
• Wednesday Shields, LICSW
• Benjamin Shuts, LICSW
• Christina M Silver, OT
• Suncrest Chiropractic PS
• Diane C Thompson, LMHC
• Yevgeniya Titov, PMHNP
• Lawrence Robert Torgersen, CO60862173
• Zina Trimble, LMT
• Koastyantin Unguryan

• Community/Retail Pharmacy in Nine Mile Falls, WA
• Providers in Nine Mile Falls, 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 Nov 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.