Healthcare Provider Details

I. General information

NPI: 1760586267
Provider Name (Legal Business Name): ELK DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E MAIN ST
DAYTON WA
99328-1351
US

IV. Provider business mailing address

176 E MAIN ST
DAYTON WA
99328-1351
US

V. Phone/Fax

Practice location:
  • Phone: 509-382-2536
  • Fax: 509-382-2067
Mailing address:
  • Phone: 509-382-2536
  • Fax: 509-382-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60214219
License Number StateWA

VIII. Authorized Official

Name: SEAN THURSTON
Title or Position: CEO/OWNER/PIC
Credential:
Phone: 509-382-2536