Healthcare Provider Details

I. General information

NPI: 1629147020
Provider Name (Legal Business Name): MARIKA, INC DBA THE CONNELL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N COLUMBIA
CONNELL WA
99326-0070
US

IV. Provider business mailing address

PO BOX 70
CONNELL WA
99326-0070
US

V. Phone/Fax

Practice location:
  • Phone: 509-234-2415
  • Fax: 509-234-2414
Mailing address:
  • Phone: 509-234-5415
  • Fax: 509-234-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00057135
License Number StateWA

VIII. Authorized Official

Name: MS. MARY MARTHA HALL
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 509-234-2415