Healthcare Provider Details

I. General information

NPI: 1104831726
Provider Name (Legal Business Name): EASTMONT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 VALLEY MALL PKWY
E WENATCHEE WA
98802-4838
US

IV. Provider business mailing address

630 VALLEY MALL PKWY
E WENATCHEE WA
98802-4838
US

V. Phone/Fax

Practice location:
  • Phone: 509-884-7254
  • Fax: 509-884-4698
Mailing address:
  • Phone: 509-884-7254
  • Fax: 509-884-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00004184
License Number StateWA

VIII. Authorized Official

Name: MIKE HOLLIDAY
Title or Position: COOWNER
Credential:
Phone: 509-884-7254