Active NPI
Suncrest Pharmacy Group, LLC
Doing business as Suncrest Pharmacy
- Community/Retail Pharmacy
- Nine Mile Falls, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- SUNCREST PHARMACY GROUP, LLC
- Doing business as
- Suncrest Pharmacy
- Practice address
- 5919F Highway 291
Nine Mile Falls, WA 99026 - Phone
- (509) 413-2030
- Fax
- (509) 413-2091
- NPI assigned
- Jun 25, 2019
- Last updated
- Nov 27, 2019
- Organization subpart
- No
NPPES NPI Registry
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
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary | ||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
5919F Highway 291
Nine Mile Falls, WA 99026
Mailing address
PO Box B
Ilwaco, WA 98624-0167
Phone (360) 642-3133
Other names 1
- Suncrest Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191107003090 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698107977 | Practice locations: Nine Mile Falls, WA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2266235 | Suncrest Pharmacy | Certificate of waiver | Apr 4, 2028 |
National Provider Directory
National Provider DirectoryLocations
5919 Highway 291
#F
Nine Mile Falls, WA 99026
Phone (509) 413-2030
5919 Highway 291
Ste F
Nine Mile Falls, WA 99026
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Spokane, WA
- NPI 1215377544
NPI Registry JSON
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": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Suncrest Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Suncrest Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Nine Mile Falls, WA
Sources for this page
- 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.