Fairway Drug, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00003781 Issued in WA

Legal business name

FAIRWAY DRUG, INC

Practice address

1758 Front St # 106
Lynden, WA 98264-1261

Phone

(360) 354-1226

Fax

(360) 354-6561

NPI assigned

Oct 27, 2006

Last updated

Oct 17, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jerry P. Koehler, RPHNPI 1992911853

Title

Manager

Phone

(360) 354-1226

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

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

Medicare medical equipment & supply locations

Locations

Practitioners 4

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.

• Jerry P. Koehler, R.PH.

  • Pharmacist
  • Lynden, WA
  • NPI 1992911853
  NPD Authorized official
• Beau Keown, PHARMD

  • Pharmacist
  • Lynden, WA
  • NPI 1144862905
  NPD
• Rob Alan Hughes, RPH

  • Pharmacist
  • Lynden, WA
  • NPI 1063712388
  NPD (past)
• Jennifer S. Koehler, R.PH.

  • Pharmacist
  • Lynden, WA
  • NPI 1558578567
  NPD (past)

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1780760454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1758 FRONT ST # 106",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641261",
            "telephone_number": "360-354-1226",
            "fax_number": "360-354-6561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1758 FRONT ST # 106",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641261",
            "telephone_number": "360-354-1226",
            "fax_number": "360-354-6561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY DRUG, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-354-1226",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "PHAR.CF.00003781",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00003781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6006720",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tami Elias
• Employment Through Connection
• Amber Erdmann, APRN, FNP-C
• Tessa Leigh Eshuis, SLPA
• Expect Abundance LLC (Expect Abundance)
• Family Care Network PLLC (FCN Draw Station - Lynden)
• Family Care Network PLLC (Lynden Family Medicine)
• Family Care Network PLLC (Lynden Family Medicine)
• Family Care Network PLLC (FCN Urgent Care - Lynden)
• Family Care Network PLLC (Lynden Family Medicine)

• Community/Retail Pharmacy in Lynden, WA
• Providers in Lynden, 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 Oct 17, 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.