Healthcare Provider Details

I. General information

NPI: 1649271214
Provider Name (Legal Business Name): CITY CENTER DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E WISHKAH ST
ABERDEEN WA
98520-6508
US

IV. Provider business mailing address

108 E WISHKAH ST
ABERDEEN WA
98520-6508
US

V. Phone/Fax

Practice location:
  • Phone: 360-532-5182
  • Fax: 360-532-5887
Mailing address:
  • Phone: 360-532-5182
  • Fax: 360-532-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00059225
License Number StateWA

VIII. Authorized Official

Name: PATRICK O DONNELL
Title or Position: OWNER
Credential:
Phone: 360-532-5182