Healthcare Provider Details

I. General information

NPI: 1255841359
Provider Name (Legal Business Name): COST LESS PHARMACY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 REGENTS BLVD SUITE 101
FIRCREST WA
98466-6039
US

IV. Provider business mailing address

1375 REGENTS BLVD SUITE 101
FIRCREST WA
98466-6039
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-1104
  • Fax: 253-565-2023
Mailing address:
  • Phone: 253-564-1104
  • Fax: 253-565-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding 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.60787458
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2171805
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier2091478
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: HIEN TRAN
Title or Position: CO-OWNER
Credential: PHARM D
Phone: 253-564-1104