Healthcare Provider Details

I. General information

NPI: 1861857161
Provider Name (Legal Business Name): LEWIS COUNTY COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 01/29/2024
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

IV. Provider business mailing address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

V. Phone/Fax

Practice location:
  • Phone: 360-669-0600
  • Fax: 360-669-0602
Mailing address:
  • Phone: 360-669-0600
  • Fax: 360-669-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHARCF60615205
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GAELON SPRADLEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 360-330-9555