Healthcare Provider Details

I. General information

NPI: 1356456305
Provider Name (Legal Business Name): BLOOMS CAMANO PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 NE CAMANO DR STE 6
CAMANO ISLAND WA
98282-7279
US

IV. Provider business mailing address

370 NE CAMANO DR STE 6
CAMANO ISLAND WA
98282-7279
US

V. Phone/Fax

Practice location:
  • Phone: 360-387-5757
  • Fax: 360-387-3901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00055981
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE BLOOM
Title or Position: OWNER
Credential:
Phone: 360-387-5757