Healthcare Provider Details

I. General information

NPI: 1497648745
Provider Name (Legal Business Name): DR. STACI LYNETTE OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20403 OLD HIGHWAY 9 SW
CENTRALIA WA
98531-7915
US

IV. Provider business mailing address

1295 FERRIER RD
WINLOCK WA
98596-9330
US

V. Phone/Fax

Practice location:
  • Phone: 360-664-3400
  • Fax:
Mailing address:
  • Phone: 360-703-1328
  • Fax: 360-703-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00051099
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: