La Conner Drug Store
Organization Active NPI Pharmacy · La Conner, WA
NPI 1689668451 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1689668451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- CF00000460 (WA)
- Legal business name
- LA CONNER DRUG STORE
- Practice address
- 708 E Morris St
La Conner, WA 98257-0477 - Phone
- (360) 466-3124
- Fax
- (360) 466-4775
- NPI assigned
- Sep 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Frederick Sanders Martin, RPH
- Title
- Pharmacist Store Owner
- Phone
- (360) 466-3124
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | CF00000460 | WA | Yes |
Addresses
Primary practice location
708 E Morris St
La Conner, WA 98257-0477
Mailing address
PO Box 477
La Conner, WA 98257-0477
Phone (360) 466-3124
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6043301 | Medicaid | WA |
Other providers in La Conner, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.